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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107207121
Report Date: 01/09/2025
Date Signed: 01/13/2025 02:53:51 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
10/17/2024 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20241017120820
FACILITY NAME:NINA'S HOMEFACILITY NUMBER:
107207121
ADMINISTRATOR:RODRIGUEZ, LETICIAFACILITY TYPE:
740
ADDRESS:6540 N. BRIARWOODTELEPHONE:
(559) 253-3024
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 5DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
03:26 PM
MET WITH:Licensee, Lanina GarciaTIME COMPLETED:
03:27 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff interfered with the residents visitations
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/9/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced complaint visit. Visit is being conducted to deliver complaint findings. LPA met with Licensee, Lanina Garcia explained reason or visit and was permitted entry into the facility. Administrator, Phoeun Marez was contacted and arrived some time later. LPA completed a health and safety check on residents in care. Residents observed in living room watching television and in rooms.

During investigation LPA completed interviews, conducted visits and reviewed documentation (Resident roster, staff roster with contact information, staff schedule for September/October 2024, physician’s reports, needs and service plans, visitors log). LPAs’ interviews with residents, observations and visits conducted (10/23/24, 12/13/24 and 1/9/25) do not support this allegation. Visitors were observed at the facility without interference. Although this allegation may or may not have occurred, it does not meet the preponderance of evidence standard per Title 22. This allegation is UNSUBSTANTIATED.

Exit interview completed with Administrator, Phoung. A copy of this report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
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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