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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209035
Report Date: 10/21/2025
Date Signed: 10/21/2025 08:15:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
10/20/2025 and conducted by Evaluator Jacques Leffall
COMPLAINT CONTROL NUMBER: 24-AS-20251020113818
FACILITY NAME:SADDLE RIDGE SENIOR LIVINGFACILITY NUMBER:
107209035
ADMINISTRATOR:REYES, ALANAFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: 120DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator: Michelle RamosTIME COMPLETED:
08:30 PM
ALLEGATION(S):
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Staff does not follow physicians orders
INVESTIGATION FINDINGS:
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On 10/21/25 at 1:00pm Licensing Program Analyst's (LPA's) J. Leffall and B. Miranda conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator (A1) Michelle Ramos.

The Department conducted interviews with staff, reviewed facility records, and reviewed resident files. LPA observed Acetaminophen 325 mg take 2 tablets by mouth every 12 hours as needed for pain administered as a daily medication per the MARS, Docusate SOD 100MG Gel CAP Take 2 tablets by mouth every morning: Count should be 22 punched out from 10/11/25. 19 tablets punched out. 3 tablets short. Levothroxine 50MCG Tab Take 1 tablet by mouth every day at 6:00pm: Count should be 15 punched out from 10/16/25. 14 tablets punched out. 1 tablet short.

Based on observation, record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficincies are being cited Per Title 22 Regulations.

Exit interview conducted. A copy of this report was distributed to Administrator which confirms signature of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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-20251020113818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SADDLE RIDGE SENIOR LIVING
FACILITY NUMBER: 107209035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/22/2025
Section Cited
CCR
87465(a)(4)
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a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self-administered medications as needed.

Based on records reviewed and interviews conducted, R1’s medication count is not accurate and medication administered does not match the medication label and the MARS, which poses an immediate Health & Safety risk to the residents.
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Licensee agrees that all Med-Tech staff complete medication training. Licensee agees to submit completion documents to CCLD by POC due date.
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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: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2