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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100400622
Report Date: 01/08/2025
Date Signed: 01/13/2025 09:20:33 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
01/08/2025 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20250108083721
FACILITY NAME:STONEHAVEN SENIOR LIVINGFACILITY NUMBER:
100400622
ADMINISTRATOR:CARTER, BENJAMINFACILITY TYPE:
740
ADDRESS:1717 SOUTH WINERY AVENUETELEPHONE:
(559) 251-8417
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:116CENSUS: 60DATE:
01/08/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jaycee SandersonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff are not assisting resident with medical appointments
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On January 8, 2025, Licensing Program Analyst (LPA) R Bruce met with Administrator, JayCee Sanderson for the purpose of delivering findings regarding the above allegation.

During the course of this investigation LPA reviewed facility documentation relevant to the complaint investigation, including resident file and medical records. Staff and family interviews were conducted. It was determined that the above allegation regarding not assisting resident with medical appointments is UNFOUNDED and Community Care Licensing is therefore dismissing the complaint.

The evidence from the investigation indicated that due to the client's dementia/alzhiemers she makes numerous unwarranted requests to go to the hospital/doctor. Her new roommate was not aware of the repetitive behavior and called in the complaint on behalf of the client. Interview with client's daughter aligned with the above information and the client's medical history.
A copy of this report was provided to the Administrator via email.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
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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