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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 12/20/2024
Date Signed: 12/20/2024 05:52:40 PM

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
09/06/2024 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20240906130954
FACILITY NAME:SUMMERFIELD OF FRESNOFACILITY NUMBER:
107208983
ADMINISTRATOR:GALINDO, BERONICAFACILITY TYPE:
740
ADDRESS:6075 N. MARKSTELEPHONE:
(559) 446-6226
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:64CENSUS: 41DATE:
12/20/2024
UNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Executive Director, Beronica GalindoTIME COMPLETED:
05:59 PM
ALLEGATION(S):
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Licensee does not ensure that residents are supervised
Staff do not assist residents with personal care needs
Licensee does not ensure that staff receive required training
Staff do not safeguard a resident's personal belongings
Staff did not ensure that hazardous items were inaccessible to residents
INVESTIGATION FINDINGS:
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On 12/20/24 Licensing Program Analyst (LPA) M. Garza completed an unannounced complaint visit to deliver findings. LPA met with Executive Directior, Beronica Galindo, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check on residents in care. Residents observed in rooms and common areas.

During investigation LPA completed interviews, toured the facility (9/10/24, 9/16/24 and 10/30/24) and reviewed records (physicians reports, pre-admission appraisals, needs and services plans, hospice care plans, central stored medication logs, MARS, staff schedules, staff trainings, employment records, emergency contact information, admission agreements, hospital records, special incident reports, resident and staff roster).

Allegation: Licensee does not ensure that residents are supervised
Record review of SIR’s, staff schedules and interviews with staff were completed. These disclosed the facility did not have coverage during the NOC shift in 1 of 4 units due to call-ins. CONT....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
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 5
Control Number 24-AS-20240906130954
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: SUMMERFIELD OF FRESNO
FACILITY NUMBER: 107208983
VISIT DATE: 12/20/2024
NARRATIVE
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CONT...

Allegation: Staff do not assist residents with personal care needs
Pictures observed, tours completed, and interviews conducted with staff and family indicate personal care needs (incontinence, grooming, bathing) are not being met.

Allegation: Licensee does not ensure that staff receive required training
LPA reviewed training records and observed staff on the schedule was not properly trained for their job. Record review showed that there were 1 staff (PM caregiver) that did not complete their training prior to being placed on the floor without supervision.

Allegation: Staff do not safeguard a resident's personal belongings
Interviews conducted with staff disclosed incontinent supplies are not properly being accounted for and going missing. LPA observed the storage room did not contain residents supplies.

Allegation: During tour completed on 9/10/24 and 9/16/24 various areas of the facility were observed with items that pose a danger to residents in care unlocked and accessible.

The allegations listed above are SUBSTANTIATED. The preponderance of evidence standard has been met per Title 22. Deficiencies cited on 9099D.

Exit interview completed with Executive Director, Beronica. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 24-AS-20240906130954
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: SUMMERFIELD OF FRESNO
FACILITY NUMBER: 107208983
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
HSC
1569.312(e)
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1569.312 Basic services requirements
Every facility required to be licensed under this chapter shall provide at least the following basic services: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being.
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All shifts will be covered and none left vacant. Staggering of time for shifts to begin has began (12/1/24) so shifts overlap. ED stated they will provide the schedule that is now being used as proof of correction.
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This requirement was not met as evidence by record review of SIR’s, staff schedules and interviews with staff. These disclosed the facility did not have coverage during the NOC shift in 1 of 4 units. This posed a potential health safety and personal rights risk to residents in care.
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Type B
01/03/2025
Section Cited
CCR
87705(c)(4)
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87705 Care of Persons with Dementia
(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal.
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ED stated Resident Care Director was provided diciplinary action for performance as they are the lead and direct report for these issues. A replacement RCD will be found if improvement is not made. Copies of any disciplinary actions for RCD will be provided to CCL as proof of correction.
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This requirement was not met as evidence by: review of documentation, tours completed and interviews conducted which all indicate personal care needs (incontinence, grooming, bathing) are not being met. This poses a potential health safety and or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20240906130954
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: SUMMERFIELD OF FRESNO
FACILITY NUMBER: 107208983
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
87411(d)
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87411 Personnel Requirements - General
(d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance:
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ED stated staff are provided 5 days of initial training and 4 days on the floor of hands on. Orientation responsibilities have been reassigned from the RCD to ED and Business Office Manager to ensure proper training is being completed prior to staff being on the floor unsupervised. A copy of the schedule with orientation days listed will be submitted to CCL as proof of correction.
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This requirement was not met as evidence by: review of records. Files review show that staff did not have the required training prior to being placed on the schedule without supervision for the NOC shift. This poses a potential health safety and or personal rights risk to residents in care.
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Type B
01/03/2025
Section Cited
CCR
87217(b)
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87217 Safeguards for Resident Cash, Personal Property, and Valuables
(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources.
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ED stated that residents on hopice are now having supplies kept in their rooms instead of the supply area. All other residents are kept in storage. ED stated they will request hopice agencies to provide a list of items provide for their residents. Sample copy of list to be provided to CCL by POC date.
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This requirement was not met as evidence by: Interviews conducted disclosed incontinent supplies are not properly being accounted for and going missing. LPA observation of storage room disclosed residents supplies were missing. This poses a health safety and or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20240906130954
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: SUMMERFIELD OF FRESNO
FACILITY NUMBER: 107208983
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
87309(a)
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87309 Storage Space
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
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ED stated that keys were distributed for the locked cabinets in the residents room. Training will be completed with all staff. In-service sign in sheet and training material to be provided to CCL by POC date.
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This requirement was not met as evidence by: LPA observation during tours completed on 9/10/24 and 9/16/24. Various areas of the facility were observed with items (sharps and chemicals) that pose a danger to residents in care unlocked and accessible.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5