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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206916
Report Date: 02/07/2026
Date Signed: 02/07/2026 01:41:00 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
01/30/2026 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20260130104916
FACILITY NAME:VILLAGE GARDENSFACILITY NUMBER:
157206916
ADMINISTRATOR:DIANNA L ELLISFACILITY TYPE:
740
ADDRESS:11910 CROCKETT COURTTELEPHONE:
(661) 587-1191
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
02/07/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Margaret Gardea
Alfredo Benavides 		TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are not adhering to the admission agreement
INVESTIGATION FINDINGS:
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On 02/07/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day visit complaint visit. LPA introduced self, stated purpose of visit, and allowed entrance by direct care staff. Administrator contacted by telephone and arrived a short time later to conduct visit with LPA.

This department has investigated the above allegation. During the course of the investigation, LPA toured the facility, conducted interviews, and reviewed documentation.

Based on LPA review of documentation, the admission agreement states that basic services includes 1) three nutritious meals per day and 2) special diets if prescribed by a doctor. Correspondence from licensee states that additional food costs for a special diet would be a charged rate without an addendum to the admission agreement. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

Exit interview conducted and a copy of this report was provided for facility records.
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
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
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
01/30/2026 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20260130104916

FACILITY NAME:VILLAGE GARDENSFACILITY NUMBER:
157206916
ADMINISTRATOR:DIANNA L ELLISFACILITY TYPE:
740
ADDRESS:11910 CROCKETT COURTTELEPHONE:
(661) 587-1191
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
02/07/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Margaret Gardea
Alfredo Benavides 		TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff did not follow special diet order for resident
INVESTIGATION FINDINGS:
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13
On 02/07/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day visit complaint visit. LPA introduced self, stated purpose of visit, and allowed entrance by direct care staff. Administrator contacted by telephone and arrived a short time later to conduct visit with LPA.

This department has investigated the above allegation. During the course of the investigation, LPA toured the facility, conducted interviews, and reviewed documentation.

The department has insufficient information regarding the above allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or disprove that the allegation occurred therefore the allegations are UNSUBSTANTIATED.

No deficiencies cited.

Exit interview conducted and a copy provided for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20260130104916
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: VILLAGE GARDENS
FACILITY NUMBER: 157206916
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2026
Section Cited
CCR
87507(g)(B)(1)
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(g) Admission agreements shall specify the following: (B) Rate for additional items and services, including: 1.A comprehensive description of and the corresponding fee schedule for all additional items and services not included in the fees for basic services shall be
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Licensee will provide a written that states any addendums to admission agreement must be in writing and adhere to Title 22 regulation 87507.

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listed. ***This was not met as evidenced by the admission agreement states that basic services includes 1) three nutrituous meals per day and 2) special diets if prescribed by a doctor. Correspondence from licensee states that additional food costs for a special diet would be a charged rate without and addeddum to the admission agreement.
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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: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3