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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 01/07/2025
Date Signed: 01/07/2025 08:34:47 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
10/28/2024 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20241028091528
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: 40DATE:
01/07/2025
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Executive Director, Beronica GalindoTIME COMPLETED:
11:29 AM
ALLEGATION(S):
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Staff did not prevent resdent from physically assaulting other residents in care.
INVESTIGATION FINDINGS:
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On 1/7/24 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced complaint visit. This visit is being conducted to deliver complaint findings. LPA met with Executive Director, Beronica Galindo. LPA explained reason for visit and was permitted entry into the facility.

During the investigation LPA completed interviews, requested/reviewed documentation (facility roster, staff schedules, physicians report, pre-placement appraisals, resident assessment, medication list, MARS, care plan, police report numbers, admission agreement and incident reports for R1). Review of records show R1 had a care plan from their previous placement (VA) indicating R1 had aggressive behaviors. Interview with staff indicated R1 would physcially assult other residents without warning. Review of SIRs showed 4 incidents occurred with other residents (8/8/24, 9/6/24, 9/15/24 and 10/6/24) within 2 months.

The allegation listed above is SUBSTANTIATED. The preponderance of evidence standard has been met per Title 22. Deficiency cited on 9099D. Exit interview completed with Executive Director, Beronica. A copy of this report, deficiency and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
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 2
Control Number 24-AS-20241028091528
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: 01/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, ...shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
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Training was completed by the Allen Flores Group for proper assessments on residents in an effort to meet their needs and keep staffing. Training records will be provided to CCL by POC date as proof of correction.
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This requirement was not met as evidence by: based on LPA record review and interviews conducted. The Licensee did not comply with this section cited above in that: R1 was involved with 4 altercations involving other residents in a period of 2 months. 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: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2