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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107203505
Report Date: 01/06/2025
Date Signed: 01/07/2025 01:07:52 PM

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
07/03/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20240703114733
FACILITY NAME:SIERRA VILLA REST HOMEFACILITY NUMBER:
107203505
ADMINISTRATOR:SUNDARI SUSAN KENDAKURFACILITY TYPE:
740
ADDRESS:175 W. SIERRA AVE.TELEPHONE:
(559) 345-4929
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:49CENSUS: 22DATE:
01/06/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sundari Susan Kendakur, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing access to the residents records
Staff are financially abusing the residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/06/2025, Licensing Program Analyst (LPA) R. Bruce conducted a subsequent unannounced complaint visit to gather additional documents and deliver complaint findings. LPA introduced self, stated purpose of visit, and allowed entrance by direct care staff. Administrator, Sundari Susan Kendakur was contacted by phone and arrived a short time later to conduct visit with LPA.

This department investigated the above allegations. Information from facility appears to be in compliance however statement and information from reporting party was incomplete. Despite LPA conducting interviews and record review during the investigation, the department had insufficient information regarding the allegations listed above. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of this report will be provided to Administrator for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
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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