157200475-8-10-2023-24-AS-SMOA-CUTV6Z-20230818161022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157200475
Report Date: 08/10/2023
Date Signed: 08/10/2023 12:27:50 PM

Unfounded

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
08/01/2023 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230801105506

FACILITY NAME:	KERN VILLAGE ASSISTED LIVING FOR SENIORS		FACILITY NUMBER:	157200475
ADMINISTRATOR:	KALA GIBSON		FACILITY TYPE:	740
ADDRESS:	32 BURLANDO ROAD		TELEPHONE:	(760) 376-6733
CITY:	KERNVILLE	STATE: CA	ZIP CODE:	93238
CAPACITY:	22	CENSUS: 2	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Licensee 1(L1) Sheryl Parmelee, Licensee 2 (L2) Anthony Barbato, and Administrator Kala Gibson		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Illegal Evictions

INVESTIGATION FINDINGS:

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

On 08/10/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced and conducted an initial complaint investigation. LPA was greeted by Brendan Ryan, cook and was granted entry into the facility. Licensee 1(L1) Sheryl Parmelee, Licensee 2 (L2) Anthony Barbato, and Administrator Kala Gibson was called and arrive later during visit. LPA discussed the above allegation and finding with Licensees and Administrator.

During the course of the investigation, LPA conducted interviews, reviewed records, and toured the facility. LPA observed R1 and R2 in the facility. Records reviewed R1 and R2 received notice informing residents’ rent increased.

Based on observation, interviews conducted, and records reviewed, the allegation above is UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted. A copy of this report was provided to Administrator, whose signature confirms receipt of report.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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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