207209043-11-27-2023-24-AS-BCHN-CYJ2YY-20231214164932

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 207209043
Report Date: 10/09/2023
Date Signed: 11/27/2023 09:13:58 AM

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
06/26/2023 and conducted by Evaluator Brianna Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230626092401

FACILITY NAME:	CEDAR CREEK SENIOR LIVING		FACILITY NUMBER:	207209043
ADMINISTRATOR:	JACKSON, SHAWNIEE		FACILITY TYPE:	740
ADDRESS:	500 N. WESTBERRY BLVD.		TELEPHONE:	(559) 673-2345
CITY:	MADERA	STATE: CA	ZIP CODE:	93637
CAPACITY:	162	CENSUS: 68	DATE:	10/09/2023
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Resident Care Director- Kimberly Jones		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is unclean
Staff failed to respond to resident's call assistance button in a timely manner

INVESTIGATION FINDINGS:

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On 10/9/2023 Licensing Program Analyst B. Miranda arrived at the facility unannounced to deliver the finding for the allegations listed above. LPA introduced herself and explained the reason for the visit. Resident Care Director (RCD) Kimberly Jones was contacted and met with LPA.

1. The Department investigated the allegation: Facility is unclean. On 7/5/23 the allegation "Facility is dirty" was previously Substantiated on complaint # 24-AS-20230306123828 regarding the facility being dirty/unclean. Various areas of the facility were noted in the citation. The above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 8, and was previously cited CCR 87303(a). The complaints overlapped with same/similar allegations with one another which is why another citation for the same regulation could not be issued while the multiple complaints were being investigated.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20230626092401

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: CEDAR CREEK SENIOR LIVING	FACILITY NUMBER: 207209043
	VISIT DATE: 10/09/2023

NARRATIVE

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2. The Department investigated the allegation: Staff failed to respond to resident's call assistance button in a timely manner. On 8/24/23 this allegation was previously Substantiated on complaint #24-AS-20230501112552 regarding staff failed to respond to resident's call assistance button in a timely manner. The above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 8, and was previously cited CCR 87468.1(a)(2). The complaints overlapped with same/similar allegations with one another which is why another citation for the same regulation could not be issued while the multiple complaints were being investigated.

No citations were issued since the allegations were previously cited on 7/5/23 & 8/24/23.

Exit interview was conducted and a copy of this report LIC909 was given to Kimberly Jones.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023

LIC9099 (FAS) - (06/04)

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