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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100400448
Report Date: 07/28/2026
Date Signed: 07/28/2026 11:10:07 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
07/22/2026 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20260722115844
FACILITY NAME:NAZARETH HOUSEFACILITY NUMBER:
100400448
ADMINISTRATOR:O'NEILL, ROSEMARY, R.N.FACILITY TYPE:
740
ADDRESS:2121 NORTH FIRST STREETTELEPHONE:
(559) 614-7757
CITY:FRESNOSTATE: CAZIP CODE:
93703
CAPACITY:110CENSUS: 81DATE:
07/28/2026
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Assisterant Director, Sara Guidry TIME COMPLETED:
11:17 PM
ALLEGATION(S):
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Staff mismanaged resident’s medication.
INVESTIGATION FINDINGS:
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On 07/28/2026 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced complaint vsiit. LPA met with Assistant Director, Sara Guidry, explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility and Health and Safety check on residents in care.

During visit LPA completed interviews, gathered and reviewed documentation. Based on records reviewed and intervies conducted the preponderance of evidence standard has been met per California Code of Regulations, Title 22. The allegation listed above is SUBSTANTIATED. Deficiency cited on attached 9099D. If not corrected the deficiency will have a direct impact to residents in care.

Exit interview completed with Assistant Director, Sara. A plan of correction was developed by Assistant Director and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
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 2
Control Number 24-AS-20260722115844
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: NAZARETH HOUSE
FACILITY NUMBER: 100400448
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
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Assistant Director stated they are going to complete medication training for both nurses involved. They have also has a training with both nurses about making sure that all medication orders go into the electronic records program. Training certificates/transcripts will be provided along with documentation on the electroic records program as proof of correction by POC date.
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This requirement was not met as evidence by records reviewed and interviews conducted. The licensee did not comply with the section cited above in that medication was provided to R1 prior to the prescribed start date from the physician. This poses an immediate health safety and or personal rights risk to residents 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.
SUPERVISOR'S NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2