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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100404229
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:47:49 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
05/03/2023 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230503134856
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:
07/21/2023
UNANNOUNCEDTIME BEGAN:
03:24 PM
MET WITH:Administrator- Elsa SnyderTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Exit doors in resident bedrooms do not open
Food is locked
INVESTIGATION FINDINGS:
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On 7/21/2023 at 3:24 p.m. Licensing Program Analyst B. Miranda arrived to the facility unannounced to deliver findings for the allegations listed above. LPA introduced herself and explained the reason for the visit with Administrator (AD) Elsa Snyder.

1. The Department investigated the allegation: Exit doors in resident bedrooms do not open. LPA conducted interviews with residents, caregivers, and administrator on 5/8/23 at 2:25 p.m. During the tour of the facility LPA attempted to open the door leading to outside from R2’s bedroom, the door would not open, and caregiver was not able to open the either. LPA also attempted to open R4's bedroom door leading to outside and was unsuccessful. Caregiver was able to open the door after using force. Sliding door on the women's side of the facility is also being locked with a stick. These doors are listed as a fire clearance exit and should be in working order and functioning properly. Due to the doors not working properly and a stick being used on the sliding door this deficiency is citable under: Title 22, Division 6, Chapter 1.

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

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
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 4
Control Number 24-AS-20230503134856
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
VISIT DATE: 07/21/2023
NARRATIVE
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2. The Department investigated the allegation: Food is locked. LPA conducted interviews with residents, caregivers, and administrator on 5/8/23 at 2:25 p.m. During the tour of the facility on 5/8/23 LPA observed the pantry door to be locked and inaccessible for residents to get food. LPA asked administrator if there were any doctor's notes with dietary restrictions, administrator stated no. By having the door locked food is inaccessible to residents. Facility is limiting snacks available to residents. This deficiency is citable under: Title 22, Division 6, Chapter 1.

Licensing Program Analyst (LPA) B. Miranda conducted the complaint investigation visit to the facility on 5/8/23. During the course of this complaint investigation LPA interviewed staff on duty, residents, administrator, observed the facility sketch, and observed the facility.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, are being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report and LIC809D were provided to Administrator Elsa Snyder.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20230503134856
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: 07/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/24/2023
Section Cited
CCR
80020(a)
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80020 Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.
This requirement is not met as evidenced by:
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Administrator will have door repaired, and pictures will be sent to LPA.
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Based on observations, interviews, & record reviews the licensee failed to properly maintain all fire clearance exits. R2 & R4's exits doors from their bedrooms are not functioning properly. A stick it being used to lock the sliding door on the women's side of the facility. This poses an immediate health, safety, 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.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20230503134856
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: 07/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement is not met as evidenced by:
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Administrator will provide copy of notes/agreement of Resident Council Meeting, which agrees pantry door will remain open.
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Based on observations & interviews the licensee failed to provide access to food by locking the pantry door. By having the pantry door locked causes interference with daily function such as eating.
This poses a potential health, safety, 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.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4