107203982-10-7-2022-24-AS-SMOA-CKJKR7-20221025080726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107203982
Report Date: 10/06/2022
Date Signed: 10/07/2022 03:22:12 PM

Unfounded

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
09/06/2022 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220906152527

FACILITY NAME:	SHINING LIGHT RCFE, THE		FACILITY NUMBER:	107203982
ADMINISTRATOR:	GALVEZ, DELIA		FACILITY TYPE:	740
ADDRESS:	2749 W. SAN CARLOS AVENUE		TELEPHONE:	(559) 449-0410
CITY:	FRESNO	STATE: CA	ZIP CODE:	93711
CAPACITY:	6	CENSUS: 3	DATE:	10/06/2022
		UNANNOUNCED	TIME BEGAN:	11:47 AM
MET WITH:	Administrator, Carlo Santos		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility accepted resident without signing a contract
Facility overcharged resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/06/2022, Licensing Program Analyst (LPA) V. Gorban arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by staff Mylene stated the purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

The Department conducted interviews and reviewed records, including a copy of the signed Admission Agreement. Based on records reviewed, the resident’s family signed a contract/admission agreement. The resident’s family also confirmed a contract was signed. Interviews conducted with the facility administrator and resident’s family confirmed that an overcharged fee was not paid. This agency has investigated the complaint allegations above and found that the complaint was UNFOUNDED.

No deficiency was observed. Exit interview was conducted. Copy of this report was printed and provided to Administrator Carlo Santos.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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 1