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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209492
Report Date: 05/09/2025
Date Signed: 05/09/2025 12:18:48 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
05/08/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250508124643
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: 37DATE:
05/09/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator Karen Dhaliwal and Licensed Vocational Nurse Diane CramerTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff do not ensure that residents are provided with a safe environment.
Staff are not properly trained.
Staff do not provided adequate laundry services.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
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13
On 05/09/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct initial complaint investigation. LPA introduced self, stated the purpose of the visit, and met with Administrator Karen Dhaliwal and Licensed Vocational Nurse Diane Cramer. LPA discussed the purpose of the visit and delivered complaint findings.

During the course of the investigation, the Department conducted interviews, toured the facility, and reviewed records. Facility is doing resident’s laundry on laundry schedule date, after resident’s shower date, and as needed. Staff completed required trainings and are redirecting residents. Based on interview conducted, observation, and records reviewed, there was insufficient evidence to prove or disprove that staff did not ensure that residents are provided with a safe environment, staff not properly trained, and staff did not provide adequate laundry services. Therefore, the above allegations are found to be UNSUBSTANTIATED. 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: 05/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025
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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