107200877-3-29-2021-24-AS-AXIG-BZSW4X-20210405165814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107200877
Report Date: 03/25/2021
Date Signed: 03/29/2021 12:04:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/12/2020 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20201112162104

FACILITY NAME:	SIERRA PALACE FOR ELDERLY #2		FACILITY NUMBER:	107200877
ADMINISTRATOR:	PERERA, NEIL MANUEL		FACILITY TYPE:	740
ADDRESS:	1492 W. BULLARD		TELEPHONE:	(559) 435-6345
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	6	CENSUS: 6	DATE:	03/25/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Elizabeth Moreland-Licensee		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Temperature inside facility is not kept within required range

INVESTIGATION FINDINGS:

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On this date, Licensing Program Analyst (LPA) David Ayers contacted the facility to deliver findings for a complaint investigation via telephone due to COVID-19 and pre-cautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the findings with Licensee Elizabeth Moreland.

During the course of the investigation, the Department conducted interviews and reviewed records. On 11/11/2020, one of the facility's two heating units became inoperational. The licensee immdeiately ordered a new heater and scheduled the installation. On 11/12/2020, the licensee purchased floor heaters and electric blankets in order to keep the residents comfortable. The second heating unit remained operational during this time.

The allegation is unsubstantiated. Exit interview conducted and a copy of this report provided to the licensee via email. A read receipt confirms the licensee receives these documents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2021

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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