107209324-8-7-2024-24-AS-BCHN-D8ESWN-20240823141436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209324
Report Date: 08/07/2024
Date Signed: 08/07/2024 02:26:27 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
03/21/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240321112201

FACILITY NAME:	GROVE, THE		FACILITY NUMBER:	107209324
ADMINISTRATOR:	BREWER, NORSHELL		FACILITY TYPE:	740
ADDRESS:	7444 NORTH CEDAR AVE		TELEPHONE:	(801) 815-0808
CITY:	FRESNO	STATE: CA	ZIP CODE:	93720
CAPACITY:	130	CENSUS: 72	DATE:	08/07/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator, Norshell Brewer		TIME COMPLETED:	11:23 AM

ALLEGATION(S):

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Staff did not meet a resident's hygiene need while in care
Staff did not provide a copy of the admission agreement to authorized representative
Staff are not abiding to admission agreement

INVESTIGATION FINDINGS:

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On 08/07/24, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility Administrator (AD) Norshell Brewer 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.

Allegation: Staff did not meet a resident's hygiene need while in care. Based on file review residents that require assistance with hygiene services documented in daily care notes. Per staff interview and records review, residents unable to provide selfcare, where assisted at different times. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Report continues on attached LIC9909-C

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: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

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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Control Number 24-AS-20240321112201

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: GROVE, THE	FACILITY NUMBER: 107209324
	VISIT DATE: 08/07/2024

NARRATIVE

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Staff did not provide a copy of the admission agreement to authorized representative. Based on records review and staff interview copy of admission agreement was provided initially to authorized representative on 12/27/23 and on 3/21/24. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

Staff are not abiding to admission agreement. Based on records review, staff and residents interview no concerns from observed from residents interviewed. During facility visit on 03/25/2024 no deficiencies were observed in regard to Admission Agreement violation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

No deficiencies were observed during this visit. Exit interview conducted, report signed and copy of this report provide to Administrator for facility records.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC9099 (FAS) - (06/04)

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