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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206916
Report Date: 04/09/2026
Date Signed: 04/09/2026 01:20:54 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
04/07/2026 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20260407141704
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: DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Aflredo BenavidesTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff mismanaged resident's medication
Staff increased the resident's fees without a proper notice
INVESTIGATION FINDINGS:
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On 4/09/26, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day visit complaint visit. LPA arrived, stated purpose of visit, and allowed entrance by staff. LPA met with Operations Manager, Alfredo Benavides to conduct visit with LPA.

This department has investigated the above allegations. During the course of the investigation, LPA toured the facility, conducted interviews, and reviewed documentation. Based on interviews conducted, it was reported that there were pills in R1's bedroom, when found they were provided to staff 2 (S2). During visit on this date, resident 2 (R2) provided a pill to LPA that was found at dining room table belong to resident 3 (R3). Responsible party for R1 was notified verbally on 3/22/26 and via text message on 3/30/26 of a rate increase effective 4/01/26. The change of change of condition for R1 occurred on 2/21/26.

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:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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-20260407141704
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: 04/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2026
Section Cited
CCR
87465(a)(4)
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(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self administered medication
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Administrator to provide medication training for staff. Facility to submit agenda to Fresno Regional office by 4/10/2026. Sign in sheets will be provided to Fresno Regional office after staff meeting is conducted but no later than 4/24/2026.
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as needed. ***This was not met as evidenced by it was reported that there were pills in R1's bedroom, when found they were provided to staff 2 (S2). During visit on this date, resident 2 (R2) provided a pill to LPA that was found at dining room table belong to resident 3 (R3).
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Type B
04/24/2026
Section Cited
HSC
1569.657
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(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed
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Administrator to review regulation and submit written statement to Department that Health & Safety Code 1569.657 has been read.
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explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. ***This was not met as evidenced by Responsible party for R1 was notified verbally on 3/22/26 and via text message on 3/30/26 of a rate increase effective 4/01/26. The change of change of condition for R1 occurred on 2/21/26.
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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: 04/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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
04/07/2026 and conducted by Evaluator Melinda Medina
COMPLAINT CONTROL NUMBER: 24-AS-20260407141704

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: DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Aflredo BenavidesTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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9
Staff did not change the resident's clothing
Staff did not provide good quality food to resident in care
INVESTIGATION FINDINGS:
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On 4/09/26, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day visit complaint visit. LPA arrived, stated purpose of visit, and allowed entrance by staff. LPA met with Operations Manager, Alfredo Benavides to conduct visit with LPA.

This department has investigated the above allegations. 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: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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