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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100400043
Report Date: 11/25/2025
Date Signed: 11/26/2025 08:52:35 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20251124093651
FACILITY NAME:BETHEL LUTHERAN HOME, INC.FACILITY NUMBER:
100400043
ADMINISTRATOR:CARTER, BENJAMINFACILITY TYPE:
740
ADDRESS:2280 DOCKERY AVENUETELEPHONE:
(559) 896-4900
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY:33CENSUS: 20DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Nursing home Administrator Jasdeep DhariwalTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Untrained staff providing care to residents
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) M. Yang conducted initial complaint investigation. LPA introduce self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with Nursing Home Administrator Jasdeep Dhariwal who stated Administrator Benjamin Carter is unavailable to attend meeting. LPA discussed complaint and delivered complaint findings to Nursing Home Administrator.

During the course of the investigation, the facility was toured, records were reviewed, and interviews were conducted. All staff files providing care and supervision for residents, were reviewed and was observed to have no training records in the file. Nursing Home Administrator confirmed staff have no training records on file. Based on interviews conducted and records reviewed, the preponderance of evidences has been met. Therefore, the above allegation is found to be SUBSTANTIATED. An exit interview was conducted. A copy of this report and appeal rights were provided to Nursing Home Administrator whose signature on this form confirms receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 24-AS-20251124093651
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BETHEL LUTHERAN HOME, INC.
FACILITY NUMBER: 100400043
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2025
Section Cited
CCR
87412(c)(2)
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87412 (c)(2) Documentation of staff training.

This requirement is not met as evidenced by:

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Licensee shall ensure that all staff have required trainings and continued trainings recorded. Licensee will submit a written statement detailing the steps the facility will take to ensure all staff training have the proper documentation including trainer’s full name, subject covered in the training, date of the training, number of hours of training per subject and have all required trainings on file. Written statement will be submitted to the Fresno CCL office by POC due date 12/05/25.
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Based on record review and interview conducted, the licensee did not comply with the section cited above when all staff files did not have the proper documentation and required trainings, which poses/posed a potential health, safety or personal rights risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20251124093651

FACILITY NAME:BETHEL LUTHERAN HOME, INC.FACILITY NUMBER:
100400043
ADMINISTRATOR:CARTER, BENJAMINFACILITY TYPE:
740
ADDRESS:2280 DOCKERY AVENUETELEPHONE:
(559) 896-4900
CITY:SELMASTATE: CAZIP CODE:
93662
CAPACITY:33CENSUS: 20DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Nursing home Administrator Jasdeep DhariwalTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff are not meeting residents diapering needs
Staff are not meeting residents showering needs
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) M. Yang conducted initial complaint investigation. LPA introduce self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with Nursing Home Administrator Jasdeep Dhariwal who stated Administrator Benjamin Carter is unavailable to attend meeting. LPA discussed complaint and delivered complaint findings to Nursing Home Administrator.

During the course of the investigation, the facility was toured, records were reviewed, and interviews were conducted. Residents are receiving showers during shower schedules and residents briefs are being changed every two hours. Based on records reviewed and interviews conducted, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. Exit Interview was conducted. A copy of this report was provided to Nursing Home Administrator, whose signature on this form confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3