207209043-2-8-2024-24-AS-BCHN-D3U26H-20240329170710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 207209043
Report Date: 02/07/2024
Date Signed: 02/08/2024 06:32:34 PM

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
10/09/2023 and conducted by Evaluator Brianna Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20231009162701

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: 69	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	02:52 PM
MET WITH:	Executive Director- Kelly Reynolds & Administrator Kimberly Elderidge		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is in disrepair
Facility does not provide a safe environment for the residents in care

INVESTIGATION FINDINGS:

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On 2/7/24 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to deliver the finding for the allegations listed above. LPA introduced herself and explained the reason for the visit. LPA met with Executive Director (ED) Kelly Reynolds and Administrator (AD) Kimberly Elderidge.

1. The Department investigated the allegation: Facility is in disrepair. On 10/13/23 LPA toured the facility and did not observe any issues within the facility regarding the facility being in despair. LPA conducted various interviews with PG&E works, facility staff and residents. There was an accident which caused the power to go out. PG&E brought generators to the facility due to the severity of the car accident and the damage it caused to the electrical lines for the facility.

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: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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-20231009162701

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: 02/07/2024

NARRATIVE

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2. The Department investigated the allegation: Facility does not provide a safe environment for the residents in care. LPA conducted interviews with staff and residents. Interviewees stated they understood there was a situation beyond the control of the facility, and the facility did there best to meet the residents needs. Interviewees did not state they had any concerns.

After conducting interviews, observing the facility, and record reviews the LPA found there to not be enough evidence for the allegations.

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 LIC9099 was provided to Executive Director Kelly Reynolds.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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