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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100404229
Report Date: 11/02/2022
Date Signed: 11/03/2022 02:18:32 PM

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
09/23/2022 and conducted by Evaluator Brianna Miranda
COMPLAINT CONTROL NUMBER: 24-AS-20220923160124
FACILITY NAME:STEPHANIE'S HOUSE A HOME FOR SPECIAL PEOPLEFACILITY NUMBER:
100404229
ADMINISTRATOR:SNYDER, ELSA V.FACILITY TYPE:
735
ADDRESS:42825 WEST VALERIATELEPHONE:
(209) 392-3778
CITY:DOS PALOSSTATE: CAZIP CODE:
93620
CAPACITY:13CENSUS: 13DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility has pest infestation.
INVESTIGATION FINDINGS:
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On 11/2/2022 at 10:00 a.m. Licensing Program Analyst (LPA) B. Miranda & S. Hurt arrived at the facility unannounced to deliver complaint findings. LPA met with Elsa Snyder- Administrator and announced the purpose of the visit.
During the investigation Reporting Party (RP) alleged they observed termites in the pantry, bed bugs, and fleas in the facility for months. RP also reports residents were bit by the pests in the facility. During the visit on 9/30/22 LPA observed fleas on LPA’s blouse, rodent dropping under a male resident’s bed and in the living room. There were dead bed bugs in a female resident’s room. During the interview the administrator stated the exterior of the facility was receiving pest control. At this time the allegation are substantiated.
The allegations listed above were SUBSTANTIATED. The following deficiencies were cited per CA Code of Regulations Title 22 – refer to the 9099D. Exit interview conducted, Report provided, Appeal rights provided


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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-20220923160124
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: STEPHANIE'S HOUSE A HOME FOR SPECIAL PEOPLE
FACILITY NUMBER: 100404229
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited
CCR
80087
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80087(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
(1) The licensee shall take measures to keep the facility free of flies and other insects.
This requirement is not met as evidenced by:
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Licensee will send proof of exterminator services to LPA by 11/04/2022 POC date.
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Based on LPA’s observations and interviews there was a pest infestation issue. LPA observed fleas and droppings in the facility. This poses an potential health, safety, or personal rights risk to persons 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.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2