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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209116
Report Date: 08/21/2024
Date Signed: 08/24/2024 08:10:12 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
06/13/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240613084044
FACILITY NAME:PACIFICA SENIOR LIVING FRESNOFACILITY NUMBER:
107209116
ADMINISTRATOR:MONTELONGO, BRANDONFACILITY TYPE:
740
ADDRESS:1715 E ALLUVIAL AVENUETELEPHONE:
(559) 298-4900
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:100CENSUS: 55DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Administrator, Brandon MontelongoTIME COMPLETED:
11:36 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is overcharging resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/21/2024, Licensing Program Analyst (LPA) V Gorban unannounced visited facility stated above to deliver findings, stated the purpose of the visit and was allowed entry into the facility by staff Judy Castro. Administrator (AD) Brandon Montelongo was notified of Licensing visit and was able to attend the visit.

Allegation: Staff is overcharging resident in care. The Department conducted interviews and reviewed records. Based on staff interviews and records reviews the R1 is independent resident and located on independent section of the facility dedicated for independent residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited during this visit. Exit interview conducted, report signed and copy of this report provided to AD for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
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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