107201055-4-23-2024-24-AS-BCHN-D4TSPS-20240430140333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107201055
Report Date: 04/19/2024
Date Signed: 04/23/2024 09:48:42 AM

Unsubstantiated

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
01/29/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240129202859

FACILITY NAME:	GARDEN TERRACE ASSISTED LIVING II		FACILITY NUMBER:	107201055
ADMINISTRATOR:	HERGENROEDER, STEVE & JULI		FACILITY TYPE:	740
ADDRESS:	1743 E. CHENNAULT		TELEPHONE:	(559) 323-1083
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	6	CENSUS: 5	DATE:	04/19/2024
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Administrator, Juli Herdenroeder		TIME COMPLETED:	10:44 AM

ALLEGATION(S):

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Correct medication is not being given at correct times
Staff is isolating and neglecting resident

INVESTIGATION FINDINGS:

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On 04/19/24, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility staff Jermaine and stated the purpose of the visit.
During this visit LPA toured the facility inside and out and observed residents in care.
Once the tour was complete, LPA discussed the findings with the Administrator.

Allegation: Correct medication is not being given at correct times. During complaint investigation the department interviewed facility staff, residents and reviewed facility files. Based of file review resident was provided medications as prescribed. 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.

Report continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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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Control Number 24-AS-20240129202859

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: GARDEN TERRACE ASSISTED LIVING II	FACILITY NUMBER: 107201055
	VISIT DATE: 04/19/2024

NARRATIVE

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Allegation: Staff is isolating and neglecting resident. R1 stated staff makes them eat meal isolated in a bedroom. Based of observation, interviews and record reviews facility serves meals in main dining room where all residents share meal time. 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.

No deficiencies were cited. Exit interview conducted, report signed and copy of this report provided to the Administrator for facility records.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

LIC9099 (FAS) - (06/04)

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