<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208908
Report Date: 09/28/2023
Date Signed: 09/29/2023 05:10:17 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
07/11/2023 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230711084903
FACILITY NAME:WESTMONT OF FRESNOFACILITY NUMBER:
107208908
ADMINISTRATOR:ERIK V. SCHUKFACILITY TYPE:
740
ADDRESS:7442 & 7468 N MILLBROOK AVETELEPHONE:
(559) 446-1266
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:155CENSUS: 102DATE:
09/28/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Jennifer FowlerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility alarm is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/28/23 Licensing Program Analyst (LPA) V Gorban visited facility stated above to deliver findings.
LPA met with Administrator (AD) Jennifer Fowler explained the purpose of the visit and discussed findings.

Allegation: Facility alarm is in disrepair

During complaint investigation LPA tested facility alarm and appears is operational. LPA reviewed facility files and interviewed staff. Although the allegation “Facility alarm is in disrepair” 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 provided to AD 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: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
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
07/11/2023 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230711084903

FACILITY NAME:WESTMONT OF FRESNOFACILITY NUMBER:
107208908
ADMINISTRATOR:ERIK V. SCHUKFACILITY TYPE:
740
ADDRESS:7442 & 7468 N MILLBROOK AVETELEPHONE:
(559) 446-1266
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:155CENSUS: 102DATE:
09/28/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Jennifer FowlerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained injuries due to staff neglect
Staff did not prevent resident from wandering from facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/28/23 Licensing Program Analyst (LPA) V Gorban visited facility stated above to deliver findings.
LPA met with Administrator (AD) Jennifer Fowler explained the purpose of the visit and discussed findings.

Allegation: Resident sustained injuries due to staff neglect

Based on LPAs observations and interviews which were conducted and record reviews, the resident was found outside with skin tear to her face and knee. 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 & Health and Safety code), are being cited on the attached LIC 9099D.

Report continues on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20230711084903
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
VISIT DATE: 09/28/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff did not prevent resident from wandering from facility.

Based on LPAs observations and interviews which were conducted and record reviews, the resident was found outside sleeping on the ground and staff was not aware of resident location. 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, report signed, and copy of this report with appeal rights provided to Administrator for facility records.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20230711084903
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: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2023
Section Cited
HSC
1569.2(c)
1
2
3
4
5
6
7
1569.2 (c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered...
This was not observed as evidenced by:
1
2
3
4
5
6
7
Administrator will provide staff in services on resident supervision, mental health, and safety. Training for dementia will be provided to staff and notify Licensing by 09/29/23
8
9
10
11
12
13
14
Based on interviews and record reviews R1's mental health, physical health , and safety was jeopardize when she end up unsupervised outside the facility in the middle of the night time. This poses an immediate health and safety risk to the residents in care.
8
9
10
11
12
13
14
Type B
10/16/2023
Section Cited
CCR
87705(b)(2)
1
2
3
4
5
6
7
87705 Care of Persons with Dementia.
(2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials.
This was not observed as evidenced by:
1
2
3
4
5
6
7
Facility will provide staff training on dementia and wandering. Facility will provide completed training to Licensing by 10/16/23
8
9
10
11
12
13
14
Based on interviews and record reviews R1 was able unsupervised leave facility building unsupervised in the middle of the night.
Facility did not provide safety measures to address wondering behavior which cause R1 being unsupervised for unknown amount of hours and outside of the facility in the middle of the night.
8
9
10
11
12
13
14
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 ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4