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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100400622
Report Date: 06/03/2025
Date Signed: 06/04/2025 03:54:46 PM

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
06/02/2025 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20250602095556
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: 74DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jaycee Sanderson, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Facility did not provide resident with an admissions agreement
Staff did not communicate with responsible party regarding resident's care
INVESTIGATION FINDINGS:
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On June 3, 2025, Licensing Program Analyst (LPA) R Bruce met with Administrator, JayCee Sanderson, Administrator for the purpose of delivering findings regarding the above allegations.

Facility did not provide resident with an admissions agreement: Documentation and file review revealed that a copy of the Admission Agreement was provided to the family and resident upon entry in July, 2024 and subsequent requests for the same document were provided.
Staff did not communicate with responsible party regarding resident's care: This was in reference to the medication the resdient is taking. Staff provided a prescription list when requested by family and facility doctor has been available to provide information. Resident does not have capacity to understand medical needs or course of treatment but information has been provided to family.
Based on investigation which included file review and staff interviews, the preponderance of evidence standard has not been met and it was determined that the above allegations are UNFOUNDED and Community Care Licensing is therefore dismissing the complaint.
An exit interview was conducted and a copy of this report was provided to the Administrator.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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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