107200486-2-23-2024-24-AS-SPIY-D2WNRD-20240229094115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107200486
Report Date: 02/23/2024
Date Signed: 02/23/2024 09:39:28 AM

Unsubstantiated

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
12/13/2023 and conducted by Evaluator Miriam Flores

COMPLAINT CONTROL NUMBER: 24-AS-20231213150724

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:	02/23/2024
		UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Lisa Luna		TIME COMPLETED:	09:55 AM

ALLEGATION(S):

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Staff force residents to shower

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced for subsequent complaint inspection. LPA discussed the purpose of the visit and the elements of the allegations with House Manager, Lisa Luna. Administrator, Elizabeth gave a verbal consent for this LPA to have this inspection with House Manager, Lisa Luna. LPA delivered the following findings:

During this visit LPA delivered investigation findings regarding the above allegation. The Department has investigated the complaint alleging: Staff force residents to shower. Based on the interviews conducted and records reviews the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted and a copy of this report was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam Flores	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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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