107200486-7-5-2023-24-AS-SMOA-CTPKCD-20230713074654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107200486
Report Date: 07/05/2023
Date Signed: 07/05/2023 12:36:56 PM

Unfounded

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
06/26/2023 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20230626153456

FACILITY NAME:	SIERRA PALACE FOR ELDERLY		FACILITY NUMBER:	107200486
ADMINISTRATOR:	PERERA-MORELAND, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	607 E. SIERRA AVENUE		TELEPHONE:	(559) 435-6345
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY:	6	CENSUS: 6	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	General Manger Virginia Jimenez and Administrator Elizabeth Perera-Moreland via telephone		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not giving residents medication

INVESTIGATION FINDINGS:

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On 07/05/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an initial 10-day
complaint inspection. LPA introduce self, stated the purpose of the visit, and met with Manager Mary Chum. LPA requested to meet with Administrator Elizabeth Perera-Moreland. Administrator was called and stated unable to attend meeting. Administrator authorized General Manger (GM) Virginia Jimenez to sign and receive report. GM arrived shortly. LPA spoke with Administator via telephone and discuss the findings.

During the course of the investigation, LPA conducted interviews and reviewed records. It was confirmed there is no client that reside at the facility listed in the complaint. Therefore, the allegation above is founded to be UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted. A copy of this report was provided to GM, whose signature on this form confirms receipt of this report.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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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