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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 08:50:15 AM

Unsubstantiated


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-20251124085118
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):
1
2
3
4
5
6
7
8
9
Unqualified staff are administering insulin
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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. R1 and R2 are diabetes who has doctor’s order for insulin medications. Residents confirmed resident administers the residents’ own insulin injections. Based on interviews conducted, the allegation alleging unqualified staff are administering insulin, is 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)
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