107206816-3-11-2024-24-AS-BCHN-D3K22L-20240320170056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206816
Report Date: 03/11/2024
Date Signed: 03/11/2024 02:25:12 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
12/08/2023 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231208081352

FACILITY NAME:	CLEAR VIEW RETIREMENT GROUP		FACILITY NUMBER:	107206816
ADMINISTRATOR:	LASHAY C DUSTIN		FACILITY TYPE:	740
ADDRESS:	2380 E. EL PASO		TELEPHONE:	(559) 298-2877
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	6	CENSUS: 6	DATE:	03/11/2024
		UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Administrator Lashay Dustin		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility did not complete a proper Admission prior to accepting a resident for care
Facility did not report incidents
Facility did not provide family with resident records

INVESTIGATION FINDINGS:

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On 3/11/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Lashey Dustin and stated the purpose of the visit.
During this visit LPA toured facility inside and out and observed residents in care and discussed findings.

Allegations: Facility did not complete a proper Admission prior to accepting a resident for care, Facility did not report incidents, Facility did not provide family with resident records.
During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.
1. Facility did not complete a proper Admission prior to accepting a resident for care. File review revealed that resident pre admission assessment was completed.

Report continues on 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: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

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-20231208081352

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: CLEAR VIEW RETIREMENT GROUP	FACILITY NUMBER: 107206816
	VISIT DATE: 03/11/2024

NARRATIVE

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2. Facility did not report incidents. During file review confirmed that the facility submitted incident report to Regional office in timely manner.

3. Facility did not provide facility with resident records. AD provided resident records copies via mail and hard copy. Family picked up actual files at the facility before LPA opened complaint.

No citations were issued during this visit.

Exit interview conducted, report signed and copy of this report provided to AD for facility records.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

LIC9099 (FAS) - (06/04)

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