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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107202374
Report Date: 10/06/2023
Date Signed: 10/06/2023 01:32:05 PM

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
05/01/2023 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20230501092207
FACILITY NAME:NEW LIGHT RESIDENTIAL CARE HOME, THEFACILITY NUMBER:
107202374
ADMINISTRATOR:GALVEZ, MARLENEFACILITY TYPE:
740
ADDRESS:1322 W. ROBERTS AVE.TELEPHONE:
(559) 261-9818
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 6DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator, Carlo SantosTIME COMPLETED:
01:48 PM
ALLEGATION(S):
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Staff do not respond to residents call at night
Staff are sleeping during their shift
INVESTIGATION FINDINGS:
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On 10/6/2023 Licensing Program Analyst (LPA) M. Garza arrived at facility to deliver complaint findings. LPA met with Direct Care Staff, Bea Choua, explained reason for visit and was permitted entry into the facility. Administrator, Carlo Santos was contacted and arrived a short time later. A health and safety was completed for residents in care.

During investigation LPA completed interviews with staff and resident(s) and reviewed documentation (physicians reports, needs and assessments). Records reviewed indicated that 4 of 6 residents have been diagnosed with dementia. Interviews conducted with staff indicated that 1 of 6 residents have wandering tendencies. Interviews with staff and resident(s) showed there are 2 live-in staff that work at the facility. Both staff are awake staff during the day and sleep during the nights. Resident(s) interviewed stated when they pushing the call light for assistance, staff do not always answer. R1 stated they have had to go to staffs room to "bang" on the door for assistance. The allegations above meet the preponderance of evidence standard per Title 22. The allegations are SUBSTANTIATED. Deficiencies cited per Title 22 on LIC 9099D.

Exit interview completed with Administrator, Carlo. 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)
Page: 1 of 2
Control Number 24-AS-20230501092207
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: NEW LIGHT RESIDENTIAL CARE HOME, THE
FACILITY NUMBER: 107202374
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/09/2023
Section Cited
CCR
87705(c)(4)(A)
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87705 Care of Persons with Dementia
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision.
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Administrator to provide POC in writing by POC date. Training will be given as needed to staff. In-service sign in sheet to be provided to CCL.
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This requirement was not met as evidence by: interviews completed with staff and resident(s) support the allegation of staff sleeping during their shifts. This poses a immediate health, safety and/or personal rights risk to residents in care.
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Type B
10/13/2023
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Administrator will assess practices and test equipment 1x month and keep log. Changing batteries as needed. In service training will be completed with staff to institute best practices. In-service training sign in sheet will be provided to CCL by POC date.
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This requirement was not met as evidence by LPA interviews with staff and residents. Call buttons are not being answered when residents are calling for assistance. This poses a potential health, safety and/or personal rights risk to 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: 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)
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