100400622-11-4-2024-24-AS-BCHN-DAY2GV-20241112162346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 100400622
Report Date: 11/04/2024
Date Signed: 11/04/2024 04:50:17 PM

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
07/31/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240731160140

FACILITY NAME:	STONEHAVEN SENIOR LIVING		FACILITY NUMBER:	100400622
ADMINISTRATOR:	CARTER, BENJAMIN		FACILITY TYPE:	740
ADDRESS:	1717 SOUTH WINERY AVENUE		TELEPHONE:	(559) 251-8417
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	116	CENSUS: 51	DATE:	11/04/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator Jay Cee Sanderson		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee does not ensure that residents have records of medical assessments prior to acceptance
Licensee does not ensure that a record for each resident is maintained at the facility
Licensee does not ensure that faucets at the facility deliver hot water
Licensee does not ensure that residents' medications have a signed order from a physician on file
Licensee does not ensure that care staff have received required training

INVESTIGATION FINDINGS:

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On 11/04/2024, Licensing Program Analyst (LPA) V Gorban met with Administrator, Jay Cee Sanderson for the purpose of delivering findings regarding the above allegations.

Allegation: Licensee does not ensure that residents have records of medical assessments prior to acceptance. During this investigation department reviewed facility records, interviewed staff and administrator. Based on records review the facility is under new Licensee since March of 2024. Based on records review and interviews resident (R1) medical assessment completed on 11/9/2020, R2 medical assessment completed on 04/10/2024, R3 medical assessment completed on 05/08/2023. When asked, the facility provided medical assessment for review.

Allegation: Licensee does not ensure that a record for each resident is maintained at the facility. Based on records review and administrator and Licensee interview records are up to date. Department review requested records at the facility and was observed up to date.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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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Control Number 24-AS-20240731160140

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: STONEHAVEN SENIOR LIVING	FACILITY NUMBER: 100400622
	VISIT DATE: 11/04/2024

NARRATIVE

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Allegation: Licensee does not ensure that faucets at the facility deliver hot water. During allegation investigation department tested facility water temperature in both buildings (Hope Building and Faith building) that appear to be in compliance ( 116 degrees F)

Allegation: Licensee does not ensure that residents' medications have a signed order from a physician on file. During investigation of this allegation department requested and reviewed residents’ files. Based on files review required documentation presented by facility and observation, residents appear to have updated and signed physician orders for resident (R1) 08/15/24, (R2) records updated on 06/19/2024, and (R3) records updated on 05/03/2024

Allegation: Licensee does not ensure that care staff have received required training. During the file review it appear staff training was completed on 9/27/2024 and another followed on 10/25/2024

Although the above allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Exit interview conducted, report signed and copy of this report provided for facility records.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

LIC9099 (FAS) - (06/04)

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