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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208813
Report Date: 03/07/2024
Date Signed: 03/11/2024 03:46:37 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
01/09/2024 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20240109112324
FACILITY NAME:MRS SCOTT'S WHERE HEART IS HOMES-CARMEL BY THE SEAFACILITY NUMBER:
107208813
ADMINISTRATOR:MAREZ, PHOEUNFACILITY TYPE:
740
ADDRESS:292 W TRENTON AVETELEPHONE:
(559) 298-7992
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 6DATE:
03/07/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Grace PetilTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are unable to effectively communicate with resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/07/24, Licensing Program Analyst (LPA) V Gorban visited facility stated above to deliver findings. LPA met with Administrator Grace Petil, explained the purpose of the visit. LPA toured facility inside and out, observed residents in care and discussed findings to allegation. Facility was taken care of 6 residents, two of them was under hospice care.

Allegation: Staff are unable to effectively communicate with resident.

During complaint investigation department reviewed facility records, staff training, interviewed residents, staff, and Administrator. During resident's stay facility employed interpreter to communicate with resident with communication barrier. 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, report signed and copy of this report provided to Administrator for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
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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