107206749-1-2-2024-24-AS-BCHN-CZN3EZ-20240119171158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206749
Report Date: 12/28/2023
Date Signed: 01/02/2024 09:23:20 AM

Unsubstantiated

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
10/02/2023 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231002141122

FACILITY NAME:	CEDARBROOK MEMORY CARE COMMUNITY		FACILITY NUMBER:	107206749
ADMINISTRATOR:	SARAH DENNIS		FACILITY TYPE:	740
ADDRESS:	1425 E. NEES AVE		TELEPHONE:	(559) 412-2299
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	68	CENSUS: 60	DATE:	12/28/2023
		UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Director of Resident Services Samantha Keith		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Staff did not assist resident with obtaining medical care

INVESTIGATION FINDINGS:

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On 12/28/23 Licensing Program Analyst (LPA) V Gorban visited facility stated above to deliver findings. LPA met with Director of Resident Services, Samantha Keith, explained the purpose of the visit. LPA toured facility inside and out, observed residents in care and discussed findings to allegations. Administrator was notified of Licensing visit.

Allegation: Staff did not assist resident with obtaining medical care.

During this investigation LPA reviewed facility records, interviewed staff, and Administrator. Facility records and witnesses confirmed that medical care was provided to resident in need. 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.

Exit interview conducted, no citations were issued during this visit. Visit report signed and copy of this report provided for facility records.

Unsubstantiated

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: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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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