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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209083
Report Date: 04/18/2025
Date Signed: 04/18/2025 02:05:25 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
01/30/2025 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250130163529
FACILITY NAME:SEQUOIA RESIDENTIAL CAREFACILITY NUMBER:
107209083
ADMINISTRATOR:MKHITARIAN, SUSANNAFACILITY TYPE:
735
ADDRESS:4441 N. SEQUOIATELEPHONE:
(559) 515-6557
CITY:FRESNOSTATE: CAZIP CODE:
93705
CAPACITY:4CENSUS: 3DATE:
04/18/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Susanna MkhitarianTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not seek medical attention in a timely manner
INVESTIGATION FINDINGS:
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On 4/18/25, Licesing Program Analyst (LPA) M. Medina and Licensing Program Manager (LPM) S. Pidgirny conducted an office meeting to deliver finding for complaint.

During complaint investigation, the facility was toured, interviews conducted and records reviewed.

Based on information gathered during investigation, resident 1 (R1) was not provided timely medical attention as needed. Administrator did not seek medical attention for R1 until told by placement agency.
The preponderance of evidence standard has been met,therefore the allegation of illegal eviction and licensee did not notify responsible person of incident is found to be SUBSTANTIATED.

A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 9099D.

Exit interview was conducted and a plan of correction developed and reviewed. A copy of this report provided to Administrator during office visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 24-AS-20250130163529
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: SEQUOIA RESIDENTIAL CARE
FACILITY NUMBER: 107209083
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2025
Section Cited
CCR
85705(b)
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(b) The facility shall develop and implement a plan which ensures that assistance is provided to the clients in meeting their medical and dental needs.

**This was not met as evidenced by: resident 1 (R1) was not provided timely medical
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Administrator will submit written statement acknowledging need for medical and dental appointments for clients in care.
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attention as needed. Administrator did not seek medical attention for R1 until told by placement agency.
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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: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
01/30/2025 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20250130163529

FACILITY NAME:SEQUOIA RESIDENTIAL CAREFACILITY NUMBER:
107209083
ADMINISTRATOR:MKHITARIAN, SUSANNAFACILITY TYPE:
735
ADDRESS:4441 N. SEQUOIATELEPHONE:
(559) 515-6557
CITY:FRESNOSTATE: CAZIP CODE:
93705
CAPACITY:4CENSUS: 3DATE:
04/18/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Susanna MkhitarianTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident sustained unexplained injuries while in care
Staff forced a resident to go on an outing
Staff restrained a resident in care
INVESTIGATION FINDINGS:
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On 4/18/25, Licesing Program Analyst (LPA) M. Medina and Licensing Program Manager (LPM) S. Pidgirny conducted an office meeting to deliver finding to complaint.

During the course of the investigation, facility was toured, records reviewed, and interviews conducted. This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED.

No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3