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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208910
Report Date: 10/16/2023
Date Signed: 10/16/2023 02:19:57 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
10/05/2023 and conducted by Evaluator Mai Yang
COMPLAINT CONTROL NUMBER: 24-AS-20231005154829
FACILITY NAME:VILLA HERMOSAFACILITY NUMBER:
157208910
ADMINISTRATOR:MANIGQUE, LESTERFACILITY TYPE:
735
ADDRESS:10808 VILLA HERMOSA DRTELEPHONE:
(661) 556-5293
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:4CENSUS: 4DATE:
10/16/2023
UNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Lester Manigque, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not allow resident to attend day program
INVESTIGATION FINDINGS:
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On 10/16/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver finding on the above allegation. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. Administrator (A1) Lester Manigque was called and arrived shortly. LPA discussed the finding with A1.

During the course of the investigation, interviews were conducted, and records were reviewed. Interviews were conducted and records reviewed confirms Administrator informed staff to have client 1 (C1) stay home from day program.

Based on records reviewed and interviews which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 6 are being cited on the attached LIC 9099D. An exit interview was conducted. A copy of this report and appeal rights was provided to the Administrator whose signature on this report confirms receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
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 2
Control Number 24-AS-20231005154829
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: VILLA HERMOSA
FACILITY NUMBER: 157208910
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2023
Section Cited
CCR
80072(a)(6)
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80072 (a)(6) Personal Rights To leave or depart the facility at any time.

This requirement was not met as evidenced by:

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Licensee shall ensure all staff review and have in-service training on client’s personal rights to met regulation. Trainings and proof of staff attendance rooster shall be submitted to the department by 10/30/23.
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Based on records reviewed and interviews conducted, C1 wanted to go to Day Program and Administrator instructed staff to have C1 to stay home from Day Program due to the client's lack of sleep which poses a potential 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: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2