107206749-9-29-2024-24-AS-BCHN-D9VUQZ-20241009154755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206749
Report Date: 09/26/2024
Date Signed: 09/29/2024 05:04:28 PM

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
07/18/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240718061012

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: 63	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Director of Resident Services, Samantha Keith		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff keep resident's restrooms locked.
Staff are not providing residents with adequate food portions.
Staff are not providing residents drinking water.
Staff do not ensure resident's grooming needs are being met.
Staff are not providing residents with activities.

INVESTIGATION FINDINGS:

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On 09/26/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with Samantha Keith Director of Resident Services, stated the purpose of the visit. During this visit LPA toured the facility inside and out, observed clients in care, and discused allegations with DRS.

Allegation: Staff keep resident's restrooms locked. Based off observations and interviews on 7/18/24 during facility visit resident’ s room restrooms checked and found unlocked for use.

Allegation: Staff are not providing residents with adequate food portions. Based of observation, staff interview and records review R1 received three meals a day and additionally provided regular snacks which were documented by facility staff.

Report continues on attached LIC9099-C

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: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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-20240718061012

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CEDARBROOK MEMORY CARE COMMUNITY	FACILITY NUMBER: 107206749
	VISIT DATE: 09/26/2024

NARRATIVE

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Allegation: Staff are not providing residents drinking water. Facility staff documented regular checks on R1 and also maintained a hydration log. Hydration checks were conducted every hour.

Allegation: Staff do not ensure resident's grooming needs are being met. Based of staff interviews and observation and records review during the visit on 7/18/24 the facility provided shower to residents as scheduled.

Allegation: Staff are not providing residents with activities. Based of records review facility providing daily activities to residents in care. During the facility visit and observation on 7/18/24 R1 was offered and refused to attend activity that day. The facility activities schedule is updated weekly and posted on the wall in main hallway for review for visitors.

Although these allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.
A copy of the report was provided to the licensee via email and exit interview conducted.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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