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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157203255
Report Date: 03/26/2024
Date Signed: 03/27/2024 04:19:34 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
03/20/2024 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20240320085715
FACILITY NAME:MARIPOSA ARFFACILITY NUMBER:
157203255
ADMINISTRATOR:SEDAM, RUSSFACILITY TYPE:
735
ADDRESS:1106 MINTER AVENUETELEPHONE:
(661) 746-4864
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY:4CENSUS: 3DATE:
03/26/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Russ SedamTIME COMPLETED:
04:41 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff leave resident unsupervised for extended periods of time
Staff are not providing adequate care and supervision to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/26/24, Licensing Program Analyst (LPA) V. Gorban visited the facility to commence a complaint investigation. During this visit LPA met with facility Administrator (AD) Russ Sedam and stated the purpose of the visit. LPA toured the facility inside and out and observed residents in care.
Once the tour was complete, LPA discussed the allegations with AD.
Allegations: Staff leave resident unsupervised for extended periods of time, Staff are not providing adequate care and supervision to resident
Based off of records review and the facility personnel interviews the residents are not left unattended in the facility at no time. During the visit on 3/26/24 based of off LPA observation the facility staff providing adequate care and supervision to residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.
Exit interview conducted, report signed and copy of this report provided to the Administrator for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024
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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