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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208983
Report Date: 05/19/2025
Date Signed: 05/19/2025 05:07:39 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
05/14/2025 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20250514141753
FACILITY NAME:SUMMERFIELD OF FRESNOFACILITY NUMBER:
107208983
ADMINISTRATOR:HUNTLEY, ROBERTFACILITY TYPE:
740
ADDRESS:6075 N. MARKSTELEPHONE:
(559) 446-6226
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:64CENSUS: 49DATE:
05/19/2025
UNANNOUNCEDTIME BEGAN:
02:23 PM
MET WITH:Business Office Manager, Bryant WardTIME COMPLETED:
05:17 PM
ALLEGATION(S):
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Staff inappropriately restrains resident.
INVESTIGATION FINDINGS:
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On 5/19/2025 Licensing Program Analyst (LPA) M. Garza completed an unannounced complaint visit. LPA was informed Executive Director (ED), Robert Huntley and Licensed Vocational Nurse (LVN), Gabriel Facio were out of the facility and unavailable currently. LPA met with Business Office Manager, Bryant Ward, explained reason for visit and was permitted entry into the facility. LPA completed a health and safety check on residents in care. Residents were observed in rooms and common areas. ED and LVN arrived some time later.

During investigation LPA completed interviews with staff, resident family members and residents. LPA collected and reviewed documentation (Resident roster and room numbers, staff schedule, special incident reports for R1, pre-placement appraisals, admission orders, physicians reports, hospice care plans, and review of physicians prescriptions). During visit it was disclosed R1 is utilizing a soft tie while in the wheelchair. Review of physicians orders do not show a prescription for a soft tie to be used. The preponderance of evidence standard has been met and the allegation above is SUBSTANTIATED. Deficiencies cited per Title 22.

Exit interview conducted with Executive Director, Robert and LVN, Gabriel. A copy of this report deficiencies and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
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-20250514141753
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: 05/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2025
Section Cited
CCR
87608(a)
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87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions...
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ED stated physicians will be contacted to obtain prescriptions, training will be completed with all staff in using soft ties, in-service sign in sheet and training material will be sent to CCL as proof of correction.
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This requirement was not met as evidence by: LPAs review of resident records, observations and interviews conducted, the licensee did not comply with the section cited above in LPA observation of resident(s) observed with soft ties. Interviews disclosed soft ties are being utilized by resident(s) and review of records did not obtain a physicians prescription to be used. 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: 05/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
LIC9099 (FAS) - (06/04)
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