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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107203505
Report Date: 04/08/2026
Date Signed: 04/08/2026 04:41:55 PM

Substantiated


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
04/01/2026 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20260401165257
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: 35DATE:
04/08/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Shannon Steele, Care CoordinatorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are not accepting resident back at the facility
INVESTIGATION FINDINGS:
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On 4/08/2026, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day complaint visit. LPA arrived, stated purpose of visit, and allowed entrance by direct care staff. Care Coordinator, Shannon Steele contacted by telephone and arrived a short time later to conduct complaint visit with LPA.

During complaint visit, LPA conducted interviews, and received copy of R1's emergency contact sheet. Care Coordinator will e-mail R1's admission agreement and medical assessment. Based on interviews, R1 was ready for discharge from the hospital on 3/24/2026 and was informed by facility on 3/24/26 that R1 could not return due to non-payment of rent. Information provided during interviews from RP indicates R1 has not had a change in condition.

Based on the interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.
.
An exit interview was conducted with Care Coordinator, Shannon Steele. A copy of this report and appeal rights were discussed and provided. A plan of correction was developed by Care Coordinator and reviewed with LPA.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
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-20260401165257
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2026
Section Cited
CCR
87224(a)
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(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)
***This was not met as evidenced by:
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Care Coordinator will contact hospital for R1 discharge back to facility and review eviction procedures. Facility to provide provide written statement to department regarding eviction procedures by plan of correction due date.
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R1 was ready for discharge from the hopsital on 3/24/2026 and was informed by facility on 3/24/26 that R1 could not return due to non-payment of rent. Information provided during interviews from RP indicates R1 has not had a change in condition.
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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.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
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