207209043-11-27-2023-24-AS-BCHN-CYJ2YZ-20231214164932

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 207209043
Report Date: 10/09/2023
Date Signed: 11/27/2023 09:15:15 AM

Unsubstantiated

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:	11:07 AM
MET WITH:	Resident Care Director- Kimberly Jones		TIME COMPLETED:	11:08 AM

ALLEGATION(S):

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Facility is in disrepair
Facility is unsanitary
Staff failed to provide a comfortable environment for residents

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 in disrepair. LPA toured the facility and did not find the facility to be in disrepair at the time. There was water damage that was being repaired in the Redwood Dining area. On 7/5/23 this allegation was previously Unsubstantiated on complaint # 24-AS-20230306123828 regarding the facility is in disrepair. There were multiple complaints overlapping with one another. Multiple complaints were investigated at the same time.

Unsubstantiated

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: Facility is unsanitary LPA toured the facility on 7/27/23 and did not find any issues with the facility being unsanitary. LPA had previously conducted staffed interviews and spoke with residents in the common area who did not report any issues regarding this allegation.

3. The Department investigated the allegation: Staff failed to provide a comfortable environment for residents. LPA previously toured the facility on 7/5/23 and did not observe any residents to be uncomfortable. LPA spoke with residents who were in the common areas and did not have complaints to report.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted and a copy of this report LIC909 was given to RCD 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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