107208908-10-16-2024-24-AS-BCHN-DAA75W-20241021212214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107208908
Report Date: 10/08/2024
Date Signed: 10/16/2024 09:08:05 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
07/05/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240705144042

FACILITY NAME:	WESTMONT OF FRESNO		FACILITY NUMBER:	107208908
ADMINISTRATOR:	EDUARDO RANGEL		FACILITY TYPE:	740
ADDRESS:	7442 & 7468 N MILLBROOK AVE		TELEPHONE:	(559) 446-1266
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	155	CENSUS: 103	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Administrator Eddie Rangel		TIME COMPLETED:	03:01 PM

ALLEGATION(S):

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Facility staff did not dispense resident’s medication as prescribed.
Facility staff did not provide adequate supervision of children in care.
Facility staff do not communicate with resident’s authorized representative.
Facility staff left residents in soiled diapers for an extended period of time.
Facility staff did not ensure restroom is clean and sanitized.
The resident’s room is malodorous.

INVESTIGATION FINDINGS:

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On 10/09/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Eddie Rangel and stated the purpose of the visit. During this visit LPA toured the facility inside and out and observed residents in care.

Allegation: Facility staff did not dispense resident’s medication as prescribed. Based on staff interview and records review no orders to provide Zyprexa to resident 1 (R1) Although Tramadol ordered as 1 tablet by mouth every six (6) hours for pain as needed.

Allegation: Facility staff did not provide adequate supervision of children in care. Based on interview and records review no children observed at the facility to supervise.
.
Report continues on attached LIC-9099 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: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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
07/05/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240705144042

FACILITY NAME:	WESTMONT OF FRESNO		FACILITY NUMBER:	107208908
ADMINISTRATOR:	EDUARDO RANGEL		FACILITY TYPE:	740
ADDRESS:	7442 & 7468 N MILLBROOK AVE		TELEPHONE:	(559) 446-1266
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	155	CENSUS: 103	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Administrator Eddie Rangel		TIME COMPLETED:	03:01 PM

ALLEGATION(S):

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Facility staff did not safeguard resident's property.

INVESTIGATION FINDINGS:

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On 10/09/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Eddie Rangel and stated the purpose of the visit. During this visit LPA toured the facility inside and out and observed residents in care.

Allegation: Facility staff did not safeguard resident's property. Based on interview and records review resident 1 (R1) lost hearing aid at the memory care building while resided at the community in June 2024. Per administrator, lost item was not reimbursed to the resident 1 (R1) family as of 10/07/2024. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation being cited on the attached LIC 9099_D.

Exit interview conducted, report signed and with appeal rights provided to Administrator 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: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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-20240705144042

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: 10/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/11/2024 Section Cited CCR 87218(a)(2)	1 2 3 4 5 6 7	87218 Theft and Loss. (a) (2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153. This regulation was not observed as evidenced by:	1 2 3 4 5 6 7	The administrator offered to review inventory list upon moving residents in to the community. Administrator also will educate family and staff on inventory process. Administrator will provide plan of correction to LPA by POC due date, 10/11/2024
	8 9 10 11 12 13 14	The facility failed to provide a replacement or monetary refund to resident when lost hearing aid for R1 while resided at the facility in June 2024, which poses health and safety risk to persons 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: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20240705144042

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: 10/08/2024

NARRATIVE

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Allegation: Facility staff do not communicate with resident’s authorized representative. Based on interview and records review facility communicated with resident responsible party and communication was not denied.

Allegation: Facility staff left residents in soiled diapers for an extended period of time. Based on interview and records review staff check on residents every 30 minutes.

Allegation: Facility staff did not ensure restroom is clean and sanitized. Based on observations during facility visits on 7/12, and 9/13, the facility staff clean residents rooms daily to maintain rooms clean and in good repair.

Allegation: The resident’s room is malodorous. Based on observations during facility visits on 7/12, and 9/13, staff interview and records review facility once observed staff clean residents rooms once notified by family, residents or staff.

Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Report continues on attached LIC9099-A

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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