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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 150404353
Report Date: 10/03/2024
Date Signed: 10/03/2024 12:00:21 PM

Substantiated


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
09/30/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240930100339
FACILITY NAME:ARC-TAFT, THEFACILITY NUMBER:
150404353
ADMINISTRATOR:HAGSTROM, MARYANNFACILITY TYPE:
775
ADDRESS:204 VAN BUREN STREETTELEPHONE:
(661) 763-1532
CITY:TAFTSTATE: CAZIP CODE:
93268
CAPACITY:45CENSUS: 29DATE:
10/03/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Maryann HagstromTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not ensure adequate care and supervision was provided to client resulting in client being left unattended
INVESTIGATION FINDINGS:
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On 10/03/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an initial complaint vist. LPA introduce self, stated the purpose of the visit, and met with Administrator Maryann Hagstrom who granted LPA entry into the facility.

During the course of the investigation, interview were conducted, and records were reviewed. On 08/26/24, C1 was left unattended at local store. On 09/27/24, C1 was left unattended by staff at a park.

Based on interview conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. An exit interview was conducted, and a copy of this report and appeal rights was provided to Administrator, whose signature confirms received of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
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 2
Control Number 24-AS-20240930100339
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: ARC-TAFT, THE
FACILITY NUMBER: 150404353
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2024
Section Cited
CCR
82078(a)
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82078 (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement.

This requirement is not met as evidenced by:
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Facility shall submit a written procedure for providing care and supervision of the clients that the facility will follow. Procedure will be submitted to Fresno CCL by 10/04/24.
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Based on interview and records review, care and supervision was not provided when C1 was left unattended on 08/26/24 and on 09/27/24, which poses an immediate health and safety risks to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2