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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209303
Report Date: 07/31/2024
Date Signed: 08/04/2024 03:42:07 PM

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
07/09/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240709120624
FACILITY NAME:PSALMS 23 LOVING CARE RESIDENTIAL IIIFACILITY NUMBER:
107209303
ADMINISTRATOR:COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:441 W ALLUVIAL AVETELEPHONE:
(559) 270-3822
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY:4CENSUS: 2DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator Iisha CooleyTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff speak inappropriately to resident
INVESTIGATION FINDINGS:
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On 07/31/2024, Licensing Program Analyst (LPA) V Gorban visited facility stated above to deliver findings. LPA met with staff Shannon Senegal, explained the purpose of the visit. LPA toured facility inside and out, observed clients in care and discussed findings to allegation.

Allegation: Staff speaks inappropriately to resident

During complaint investigation department reviewed facility records, staff training, interviewed staff and Administrator, and observed the staff and clients during facility visits. Based on observations, staff and client interview during facility visit on 07/11/24, 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.

Report continues on attached LIC9099-A
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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
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
07/09/2024 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20240709120624

FACILITY NAME:PSALMS 23 LOVING CARE RESIDENTIAL IIIFACILITY NUMBER:
107209303
ADMINISTRATOR:COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:441 W ALLUVIAL AVETELEPHONE:
(559) 270-3822
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY:4CENSUS: 2DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator Iisha CooleyTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff do not allow resident to possess personal belongings
INVESTIGATION FINDINGS:
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13
On 07/31/2024, Licensing Program Analyst (LPA) V Gorban visited facility stated above to deliver findings. LPA met with staff Shannon Senegal, explained the purpose of the visit. LPA toured facility inside and out, observed residents in care and discussed findings to allegation.

Allegation: Staff do not allow resident to possess personal belongings.

On 07/11/24, during staff interview and records review revealed that C1 requested personal items in possession of facility staff and did not received it over a week. During staff interview it was revealed that it was unknown when personal items will be returned to C1. Based on observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations being cited on the attached LIC 9099-D.
Exit interview conducted, report with appeal rights provided to Administrator for facility records
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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-20240709120624
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PSALMS 23 LOVING CARE RESIDENTIAL III
FACILITY NUMBER: 107209303
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2024
Section Cited
CCR
85072(b)(6)
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85072 Personal Rights (b) The licensee shall insure that each client is accorded the following personal rights. (6) To possess and use his/her own personal items. This was not observed as evidenced by:
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The facility staff and administrator will ensure clients possessions available if requested.

No further details.
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Based on staff and client interview, the facility has in possession of personal items for C1 that was requested back over a week ago and have not received it on 7/11/24 which poses potential health and safety 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: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3