107209492-9-12-2025-24-AS-SMOA-DLTMQ5-20250924094806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107209492
Report Date: 09/12/2025
Date Signed: 09/12/2025 10:11:58 AM

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
07/15/2025 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20250715135159

FACILITY NAME:	AUTUMN RIDGE ASSISTED LIVING		FACILITY NUMBER:	107209492
ADMINISTRATOR:	DHALIWAL, KAREN		FACILITY TYPE:	740
ADDRESS:	14280 W STANISLAUS AVE		TELEPHONE:	(661) 972-4646
CITY:	KERMAN	STATE: CA	ZIP CODE:	93630
CAPACITY:	54	CENSUS: 46	DATE:	09/12/2025
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Karen Dhaliwal, Administrator		TIME COMPLETED:	10:20 AM

ALLEGATION(S):

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Resident sustained severe pressure injuries due to staff neglect
Staff are not providing adequate food service to residents
Staff are not providing residents authorized representative with resident's documents
Staff are not ensuring the facility is clean

INVESTIGATION FINDINGS:

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On 09/12/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to delivered complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit, and met with Administrator Karen Dhaliwal.

During the course of the investigation, the department conducted interviews, received copies of records, and toured the facility. Based on interviews conducted, records reviewed, and observations, R1 is received hospice care for pressure injury. Staff assist in feeding food for residents that requires feeding. Facility provided requested documents to resident’s authorized representative. Facility was observed inside and outside. Facility was observed to be cleaned and free of odor. Therefore, the preponderance of evidence standard has not been met, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to 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: 09/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025

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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