107209480-4-17-2026-24-AS-SPIY-DTMLUR-20260430090421

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209480
Report Date: 04/17/2026
Date Signed: 04/17/2026 11:36:18 AM

Unsubstantiated

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
01/15/2026 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20260115134506

FACILITY NAME:	STONEHAVEN SENIOR LIVING		FACILITY NUMBER:	107209480
ADMINISTRATOR:	SALOW, DONALD		FACILITY TYPE:	740
ADDRESS:	1717 SOUTH WINERY AVENUE		TELEPHONE:	(659) 251-8417
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	116	CENSUS: 100	DATE:	04/17/2026
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Radhika "Rads" Jawa, Administrator		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure medications are being dispensed as prescribed
Staff did not ensure resident records were updated in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 4/17/1026, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day complaint visit. LPA arrived, stated purpose of visit and allowed entrance. LPA met with Administrator to conduct complaint visit.

During complaint visit, LPA toured facility, conducted interviews and gathered documentation. The information obtained during interviews states that Resident 1 (R1) was prescribed medication and that the medication was not administered when received. There are fax records documenting a physician order but it does not indicate who it was faxed to and the time stamp information for the fax is prior to when ordered by the physician, the medication for R1 had not been received by facility.

Although the allegation may have happened, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Administrator and copy of report this report was provided for facility records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2026

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 1