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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209035
Report Date: 12/18/2025
Date Signed: 12/18/2025 02:24:30 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
12/12/2025 and conducted by Evaluator Jacques Leffall
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20251212093745

FACILITY NAME:SADDLE RIDGE SENIOR LIVINGFACILITY NUMBER:
107209035
ADMINISTRATOR:AYALA-MONTELONGO BRANDONFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: 112DATE:
12/18/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator: Brandon Ayala-MontelongoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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On 12/18/25 at 9:00am Licensing Program Analyst's (LPA's) J. Leffall and M. Vega conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator (A1) Brandon Ayala-Montelongo.

The Department conducted interviews with Administrator and staff. The Department requested the Safeguard for Property Valuables/Inventory form and facility did not posess document on R1's behalf.

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 with Appeal Rights was distributed to Licensee Representative which confirms signature of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
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 3
Control Number 24-AS-20251212093745
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: 12/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2026
Section Cited
CCR
87217(g)(2)
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(g) Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care, including, but not limited to the following:

(2) Records of residents' cash resources and other valuables entrusted to the licensee for safekeeping shall include a copy of the receipt furnished to the resident as specified in (b) above or to his responsible person. The receipt provided to the resident for money or valuables entrusted to the licensee shall be original and include the resident's and/or his responsible person's signature.
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Licensee agrees to audit all resident files and ensure every resident has a Safeguard For Property Values (Inventory) form on file and signed by each resident or responsible party. Licensee agrees to ensure all forms are completed and contact CCLD by POC due date.
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Based on observation, interview, record review, the licensee did not comply with the section cited above in that 1 out of 1 resident did not possess the Safeguard for Property Values form in resident file which poses/posed a potential health, safety or personal rights risk to persons 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: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3