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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157202422
Report Date: 09/09/2024
Date Signed: 09/09/2024 01:53:34 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
09/04/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240904150054
FACILITY NAME:MOUNTAIN VISTA SENIOR CAREFACILITY NUMBER:
157202422
ADMINISTRATOR:HUNT, DANIELFACILITY TYPE:
740
ADDRESS:20001 PIEDRA DRIVETELEPHONE:
(661) 822-3556
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY:6CENSUS: 3DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee Daniel HuntTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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8
9
Licensee does not ensure facility has a certified administrator
Staff did not report incident involving resident as required.
Licensee does not ensure facility is in good repair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/09/24, Licensing Program Analysts (LPA) M. Yang and K. Kaur arrived unannounced to conduct an initial complaint inspection. LPAs introduce selves, stated the purpose of the visit, and met with Licensee/ Administrator Daniel Hunt. LPAs conducted visit and delivered findings to Licensee.

During the course of the investigation, the department conduct interviews, reviewed records, and toured the facility. Licensee/Administrator who is listed as the Administrator, the Administrator certificate has an expiration date of 08/30/2019. Licensee confirmed, the facility did not report incident to the department when residents are hospitalized. The dishwasher is not leaking water. A loud noise was coming from the dryer while the dryer was operating. Upon LPAs arrival, outside was observed free of debris.

Based on interviews conducted, records reviewed, and observation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report and appeal rights was provided to the Licensee/Administrator, whose signature confirms received of this report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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 4
Control Number 24-AS-20240904150054
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: MOUNTAIN VISTA SENIOR CARE
FACILITY NUMBER: 157202422
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2024
Section Cited
CCR
87405(a)
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2
3
4
5
6
7
87405(a) All facilities shall have a qualified and currently certified administrator. All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.

This requirement was not met:
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Licensee state will assign an Administrator who has a current Administrator certificate. Once certified Administrator has been assigned, Licensee shall send request for Administrator change to the department shall be submitted to the Fresno CCL by the POC due date 10/07/24.
8
9
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14
Based on interviews conducted and records reviewed, Licensee/ Administrator do not have a current Administrator certificate which poses a potential health and safety and personal rights risk to the person in care.
8
9
10
11
12
13
14
Type B
09/20/2024
Section Cited
CCR
87211(a)(1)
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7
87211 (a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.

This requirement was not met:
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7
Licensee stated Licensee will submit statement of how to meet the reporting requirements to Fresno CCL by POC due date 09/20/24.
8
9
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14
Based on interviews conducted and records reviewed, Licensee did not report written Incident reports to the department as required after incidents occurred which poses a potential health and safety and personal rights risk to the person in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20240904150054
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: MOUNTAIN VISTA SENIOR CARE
FACILITY NUMBER: 157202422
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2024
Section Cited
CCR
87303(a)
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2
3
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5
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7
87303(a) The facility shall be clean, safe, sanitary and in good repair at all times.

This requirement was not met:
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7
Facility dishwasher and dryer shall be replaced and/or in good repaired. Proof of dishwasher and dryer in good repaired and/or replaced shall be submitted to the Fresno CCL by the POC due date 10/07/24.
8
9
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14
Based on observation and interviews conducted, the dishwasher is not operational and is broken. The dryer was operating with a loud noise which poses a potential health and safety and personal rights risk to the person in care.
8
9
10
11
12
13
14
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2
3
4
5
6
7
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5
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7
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5
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7
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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.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
09/04/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240904150054

FACILITY NAME:MOUNTAIN VISTA SENIOR CAREFACILITY NUMBER:
157202422
ADMINISTRATOR:HUNT, DANIELFACILITY TYPE:
740
ADDRESS:20001 PIEDRA DRIVETELEPHONE:
(661) 822-3556
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY:6CENSUS: 3DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Licensee Daniel HuntTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee made inappropriate comments with residents present.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/09/24, Licensing Program Analysts (LPA) M. Yang and K. Kaur arrived unannounced to conduct an initial complaint inspection. LPAs introduce selves, stated the purpose of the visit, and met with Licensee/ Administrator Daniel Hunt. LPAs conducted visit and delivered finding to Licensee.

During the course of the investigation, the Department conducted interviews. Based on interviews which were conducted, Licensee was alleged made inappropriate comments with resident present, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided to the Licensee/Administrator, whose signature confirms received of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4