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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107201840
Report Date: 05/07/2024
Date Signed: 05/07/2024 11:00:05 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
03/07/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240307103125
FACILITY NAME:MARIAN HOMES 3FACILITY NUMBER:
107201840
ADMINISTRATOR:JANARDHAN NAGARAJFACILITY TYPE:
740
ADDRESS:3238 JASMINE AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 5DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Sundari KendakurTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff overcharging resident for cigarettes.
INVESTIGATION FINDINGS:
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On 5/07/2024, Licensing Program Analyst (LPA) V. Gorban and Licensing Program Manager (LPM) S. Moua met with Administratr Sundari "Susan" Kendakur and Care Coordinator Jean to discuss the above allegations and deliver findings.
The Department conducted interviews and reviewed records. Based on the records reviewed, the facility failed to provide receipts detailing the breakdown of a carton of cigarettes and how resident’s P&I funds were used to purchase the item. The Department was only provided payment receipts that does not indicate how many cartons and what type of cigarettes were purchased. The ledger provided show discrepancies because the resident was charged $32.75 in 2021, $76.91 in 2023, and then #32.75 in 2023. The preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

See citations on the attached LIC. 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 24-AS-20240307103125
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: MARIAN HOMES 3
FACILITY NUMBER: 107201840
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/08/2024
Section Cited
CCR
87217(g)(1)
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87217(g)(1) Safeguards for Resident Cash, Personal Property, and Valuable Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care…Records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order…this requirement was not met as evidenced by:
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POC – Facility administrator agrees to review the resident’s P&I fund ledgers and reimbursed the resident or their responsible party for any overpayment made during the resident’s stay at the facility. A plan as part of the POC will be submitted to the CCL office by the due date.
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Based on records reviewed, the facility failed to provide supporting receipts of the cigarettes purchased and charged to the resident, which poses an immediate health, safety, and personal rights risk to the residents in care.
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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: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
03/07/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240307103125

FACILITY NAME:MARIAN HOMES 3FACILITY NUMBER:
107201840
ADMINISTRATOR:JANARDHAN NAGARAJFACILITY TYPE:
740
ADDRESS:3238 JASMINE AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 5DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Sundari KendakurTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
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7
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9
Staff charged for transportation services
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) V. Gorban and Licensing Program Manager (LPM) S. Moua met with Administrator Sundari "Susan" Kendakur and Care Coordinator Jean to discuss the above allegations and deliver findings.
The Department conducted interviews and reviewed records. Based on the interviews conducted and records reviewed, resident’s admission agreement states that transportation services to and from medical appointments are not covered in the monthly fee. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated.

Exit interview conducted, report signed and with appeal rights provided to Administrator for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3