107208908-7-14-2023-24-AS-BCHN-CU9S99-20230731134022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208908
Report Date: 07/05/2023
Date Signed: 07/14/2023 07:39:50 AM

Substantiated

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
04/04/2023 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230404100407

FACILITY NAME:	WESTMONT OF FRESNO		FACILITY NUMBER:	107208908
ADMINISTRATOR:	ERIK V. SCHUK		FACILITY TYPE:	740
ADDRESS:	7442 & 7468 N MILLBROOK AVE		TELEPHONE:	(559) 446-1266
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	155	CENSUS: 140	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Michelle Gonzalez, RSD		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not dispense medication as prescribed

INVESTIGATION FINDINGS:

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On 7/05/23, Licensing Program Analyst (LPA) V Gorban conducted the subsequent complaint investigation visit to the facility. LPA met with Michelle Gonzalez, Residential Services Director (RSD), explained the purpose of the visit, and discussed allegation findings. Administrator Erik Schuk was not available.
Allegation: Facility staff did not dispense medication as prescribed
During the course of investigation of this complaint LPA interviewed facility staff, obtained and reviewed facility records. Medication was not provided to resident as prescribed. Facility file had medication on record but was not provided to R1 as prescribed. Based on observations, interviews which were conducted, and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 8, are being cited on the attached LIC 9099D.
Exit interview conducted with RSD. Copy of this report signed and provided with appeal rights for facility records.

Substantiated

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: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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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Control Number 24-AS-20230404100407

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: WESTMONT OF FRESNO	FACILITY NUMBER: 107208908
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/05/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/05/2023 Section Cited CCR 87465(c)(2)	1 2 3 4 5 6 7	87465(c)(2) Incidental Medical and Dental Care: ....Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Facility will ensure to educate staff and provide medication training. All in service medication training will be completed and copy provided to CCL for the plan of correction by 07/07/23.
	8 9 10 11 12 13 14	Based on interviews and record reviews facility staff failed to give medication as prescribed and resident missed medications, which poses an immediate Health and Safety risc to the resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

LIC9099 (FAS) - (06/04)

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