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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209235
Report Date: 10/18/2025
Date Signed: 10/18/2025 07:35:04 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
09/10/2025 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20250910142445
FACILITY NAME:TLC HOME CARE 2FACILITY NUMBER:
157209235
ADMINISTRATOR:ARRIETA JR, RODRIGO A.FACILITY TYPE:
740
ADDRESS:207 RIESLING VINES STTELEPHONE:
(661) 203-7565
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:6CENSUS: 3DATE:
10/18/2025
UNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Administrator, Rodrigo ArrietaTIME COMPLETED:
12:59 PM
ALLEGATION(S):
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Staff did not provide proper medication assistance to resident in care
Staff did not provide proper supervision to resident in care
INVESTIGATION FINDINGS:
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On 10/18/2025 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced complaint visit. LPA met with Direct Support Professional, Lourdisita Villancio, explained reason for visit and was permitted entry. Administrator, Rodrigo Arrieta was contacted and arrived some time later. LPA completed a tour of the facility inside and out and completed a health and safety check on residents in care. There are currently 3 residents residing at the facility. 1 is currently receiving hopsice services and bedridden. All residents are non-ambulatory.

During complaint investigation documentation was requested and reviewed. Tour of facility was completed and interviews were conducted. R1's file disclosed R1 was bedridden and unable to leave the room without assistance. Interviews with staff disclosed R1 was "aggressive towards staff" and "required a lot of care". S1 further described R1's "behaviors throughout the night disrupted the other residents' sleep" and how they were handled. S1 stated R1 would bang something on the floor/walls to get staffs attention and would do this throughout the night because the door was closed. CONT...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2025
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-20250910142445
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: TLC HOME CARE 2
FACILITY NUMBER: 157209235
VISIT DATE: 10/18/2025
NARRATIVE
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CONT...

Medication Administration Records (MAR) showed that R1 medications were being signed off by staff as prescribed for the months of May, June and July of 2025. However the facility does not have a MARS for the month of August 2025. Facility generated sign off book shows that R1 was receiving medication from 8/1/2025 through 8/6/2025 but does not show R1 received medications after 8/6/2025. LPA observed a container of medication in the master bedroom closet full of R1's medications that were not provided and without explanation from Administrator.

The preponderance of evidence standard has been met. The allegations above have been SUBSTANTIATED. Deficiencies have been issued per California Code of Regulations, Title 22, on the attached 9099D. Deficiencies if not corrected will have a direct impact to residents in care.

Exit interview completed with Administrator, Rodrigo. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20250910142445
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: TLC HOME CARE 2
FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/20/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…
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Administor stated they provided all medication to family of R1. A plan of correction will be submitted to CCL by POC date to include all staff training in medication management. In-service sign in sheets and training material will be provided to CCL once completed.
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This requirement was not met as evidence by: records reviewed and LPAs observations. The licensee did not comply with the section cited above in that Medication Administration Records for the month of August was missing. LPA observations of a large container full of R1s medications were in the master bedroom closet unused for several months. This poses an immediate health safety and or personal rights risk to persons in care.
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Type B
10/31/2025
Section Cited
CCR
87405(d)(1)
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87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents.
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Administrator stated they were unaware that Preplacement appraisals, needs and services plans and reappraisals needed to be done annually and more frequently if needed. Administrator stated they will look and take additional training to assist them in assessing residents better at intake. Administrator stated they will provide verification of trianing completion to CCL by POC date.
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This requirement was not met as evidence by: records reviewed, and interviews conducted with staff. R1 was bedridden and unable to get out of bed without assistance. Interviews disclosed bedroom door was kept closed and R1 was not provided a way to ask for help when needed. This poses a potential health safety and or personal rights risk to 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: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3