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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206907
Report Date: 06/11/2026
Date Signed: 06/11/2026 02:29:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
10/24/2025 and conducted by Evaluator Daiquiri Boyd
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20251024130046
FACILITY NAME:UNION VILLAFACILITY NUMBER:
157206907
ADMINISTRATOR:MONTIANO, NANCYFACILITY TYPE:
735
ADDRESS:1102 S. UNION AVE.TELEPHONE:
(661) 323-0768
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:89CENSUS: 52DATE:
06/11/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nancy MontianoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not ensure that the facility was kept free of pests
Staff did not provide proper medication assistance to clients in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daiquiri Boyd conducted the subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA toured faciltiy, interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegations are SUBSTANTIATED. A review of resident medication showed that a resident prescription was last administered on 5/31/26, has 4 refills left and has not yet been refilled. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 1), are being cited on the attached LIC 9099D.
LPA observed alive and dead bed bugs in 1 of the 4 rooms toured, as well as beetles and roaches in 4 of the 4 resident rooms toured. Altough this allegation is substantiated, a citation was not issued on this day due to citation CCR 80087(a)(1) being issued during the Annual Inspection on 6/9/2025.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Shawna Doucette
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
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 3
Control Number 24-AS-20251024130046
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: UNION VILLA
FACILITY NUMBER: 157206907
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/12/2026
Section Cited
CCR
80075(b)
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(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidenced by a resident had taken the last Rexulti 4mg pill on 5/31/26. The prescription had 4 refills, but the facility did not refill the prescription
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Facility will retrain the staff responsible for administration of medications by 6/15/26 and submit the proof of training, along with the training materials covered and staff signatures of who attended. This will be faxed to Licensing.
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to prevent missed doses; which poses an immediate risk to the health, safety, or personal rights risk to the residents 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: Shawna Doucette
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
10/24/2025 and conducted by Evaluator Daiquiri Boyd
COMPLAINT CONTROL NUMBER: 24-AS-20251024130046

FACILITY NAME:UNION VILLAFACILITY NUMBER:
157206907
ADMINISTRATOR:MONTIANO, NANCYFACILITY TYPE:
735
ADDRESS:1102 S. UNION AVE.TELEPHONE:
(661) 323-0768
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:89CENSUS: 52DATE:
06/11/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nancy MontianoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not prevent client in care from being physically abused at the facility
Staff did not prevent clients in care from engaging in inappropriate interactions
Staff did not ensure that clients attend their health care appointments
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daiquiri Boyd conducted the complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations. The Department has investigated the complaint alleging: staff did not prevent client in care from being physically abused at the facility, staff did not prevent clients in care from engaging in inappropriate interactions, and staff did not ensure that clients attend their health care appointments. Based on the interviews conducted and/or records review the above allegation is UNSUBSTANTIATED. 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.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Shawna Doucette
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3