107203505-2-1-2024-24-AS-SPIY-D29PVC-20240208103856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107203505
Report Date: 02/01/2024
Date Signed: 02/01/2024 09:26:49 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
09/08/2023 and conducted by Evaluator Miriam Flores

COMPLAINT CONTROL NUMBER: 24-AS-20230908153556

FACILITY NAME:	SIERRA VILLA REST HOME		FACILITY NUMBER:	107203505
ADMINISTRATOR:	SUNDARI SUSAN KENDAKUR		FACILITY TYPE:	740
ADDRESS:	175 W. SIERRA AVE.		TELEPHONE:	(559) 347-9900
CITY:	CLOVIS	STATE: CA	ZIP CODE:	93612
CAPACITY:	49	CENSUS: 41	DATE:	02/01/2024
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Sundari Susan Kendakur		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Facility staff failed to provide supervision resulting in resident assaulting another resident
Facility accepts residents who are under the age of 60 and incompatible
Facility cannot meet the needs of its residents

INVESTIGATION FINDINGS:

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On 01/31/24 Licensing Program Analyst (LPA) M. Flores met with Licensee, Sundari Susan Kendakur. LPA stated the purpose of the visit and was allowed entry by care staff. LPA delivered findings with Care coordinator Luijean “Jean” De Castro Abragan and Licensee, Sundari Susan Kendakur.

Allegation: Facility staff failed to provide supervision resulting in resident assaulting another resident.
During the investigation, the Department reviewed records and conducted interviews. Based on interviews and record review, there is not a preponderance of evidence to prove that the facility staff failed to provide supervision resulting in resident assaulting another resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Facility accepts residents who are under the age of 60 and incompatible

(continue 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam Flores	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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-20230908153556

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SIERRA VILLA REST HOME	FACILITY NUMBER: 107203505
	VISIT DATE: 02/01/2024

NARRATIVE

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During the investigation, the Department reviewed residents’ files and conducted interviews with staff and clients. Based on interviews and file reviews it was found that the facility accepts residents who are under the age of 60, there is not a preponderance of evidence to prove incompatibility and prove that the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Facility cannot meet the needs of its residents

During the investigation, the Department reviewed records and conducted interviews. Based on interviews, there is not a preponderance of evidence to prove that facility cannot meet the needs of its residents and prove that the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted and a copy of this report provided to the Care coordinator Luijean “Jean” De Castro Abragan whose signature confirms receipt of this report. Appeal of rights provided to the Licensee.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam Flores	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC9099 (FAS) - (06/04)

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