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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107201663
Report Date: 10/06/2023
Date Signed: 10/06/2023 10:26:11 AM

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
08/25/2023 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20230825152929
FACILITY NAME:SERENITY LIVINGFACILITY NUMBER:
107201663
ADMINISTRATOR:JONES, JOSIANEFACILITY TYPE:
740
ADDRESS:2605 W. BARSTOW AVENUETELEPHONE:
(559) 449-0504
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 2DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Licensee, Josiane JonesTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff are financially abusing resident in care.
INVESTIGATION FINDINGS:
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On 10/6/2023 an NCC office meeting was conducted with Licensee Josiane Jones, Attorney Jacob Reinhardt and DIrect Care Staff, Elaine Saucedo to discuss the above allegation.

The Department conducted interviews and reviewed records. It was found that the Licensee Representative, Josiane Jones added their name to R1's bank account.

Based on the findings the perponderance of evidence standard has been met and the allegation is SUBSTANTIATED per Tiltle 22. Deficiency cited on the attached 9099D.

An exit interview was completed. A copy of this report and appeal rights given.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
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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Control Number 24-AS-20230825152929
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: SERENITY LIVING
FACILITY NUMBER: 107201663
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/09/2023
Section Cited
CCR
87217(d)(4)
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Safeguards for Resident Cash, Personal Property, and Valuables - …no licensee or employee of a facility shall: become the joint tenant on any account specified in Section 87217(h) with a resident.
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Licensee representative will submit a plan to correct and pay back the overpayment due to the resident. The plan will include the amount due, how restitution will be made and the date it will be made by. Proof of the plan overpayment will be submitted to the CCL office for review.
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Based on records reviewed, the licensee added herself to R1’s bank account.
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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.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2