107209116-7-21-2024-24-AS-BCHN-D87UMZ-20240816154306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209116
Report Date: 07/16/2024
Date Signed: 07/21/2024 11:51:49 AM

Unsubstantiated

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
03/05/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240305100554

FACILITY NAME:	PACIFICA SENIOR LIVING FRESNO		FACILITY NUMBER:	107209116
ADMINISTRATOR:	RANGEL, EDDIE		FACILITY TYPE:	740
ADDRESS:	1715 E ALLUVIAL AVENUE		TELEPHONE:	(559) 298-4900
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	100	CENSUS: 56	DATE:	07/16/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Brandon Montelongo		TIME COMPLETED:	11:30 PM

ALLEGATION(S):

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Facility is not meeting resident's dietary needs.
Facility staff are violating residents personal rights.

INVESTIGATION FINDINGS:

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On 07/16/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Brandon Montelongo and stated the purpose of the visit. During this visit LPA toured the facility inside and out and observed residents in care. Once the tour was complete, LPA discussed the findings with the AD.

Allegations: Facility is not meeting resident's dietary needs, and Facility staff are violating residents personal rights. During the facility visit on 03/06/24, interviews, and records review, these allegations are unsubstantiated. Although the allegations may have happened or valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Exit interview conducted, report signed and copy of this report provided to Administrator for facility records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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