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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209492
Report Date: 03/24/2025
Date Signed: 03/24/2025 02:23:09 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
03/18/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250318164041
FACILITY NAME:AUTUMN RIDGE ASSISTED LIVINGFACILITY NUMBER:
107209492
ADMINISTRATOR:DHALIWAL, KARENFACILITY TYPE:
740
ADDRESS:14280 W STANISLAUS AVETELEPHONE:
(661) 972-4646
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY:54CENSUS: 36DATE:
03/24/2025
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Administrator Karen DhaliwalTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Staff allows resident to smoke while oxygen tank(s) are in use.
Staff allows resident to have access to a lighter.
Unqualified staff disposing medications.
INVESTIGATION FINDINGS:
1
2
3
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On 03/24/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation. LPA introduced self, stated the purpose of the visit, and met with Administrator Karen Dhaliwal. LPA deliver complaint findings on the above allegations.

During the course of the investigation, the Department conducted interviews, toured the facility, and reviewed records. Resident was observed requesting for cigarette from staff and staff lighting cigarette for resident outside. The department observed resident smoking outside in designated area. Disposed medications are disposed by medication technicians and management staff into a pharmaceutical container.

Based on interviews conducted, observations, and records reviewed, preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator, whose signature on this form confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2025
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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