207209043-2-8-2024-24-AS-BCHN-D3U2GD-20240329172257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 207209043
Report Date: 02/07/2024
Date Signed: 02/08/2024 06:31:31 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-20231009155452

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:	03:04 PM
MET WITH:	Executive Director- Kelly Reynolds & Administrator Kimberly Elderidge		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not provide adequate supervision resulting in residents wandering away from facility
Facility was left without electricity
Staff do not provide adequate food service
Resident Council is ran by facility staff
Staff do not provide activities to 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 findings 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: Staff do not provide adequate supervision resulting in residents wandering away from facility. LPA interviewed staff and residents. On interviewee stated there was a resident who was out of memory care and was accompanied by staff. There no other issues reported.

2. The Department investigated the allegation: Facility was left without electricity. LPA conducted interviews with PG&E workers, 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. PG&E stated generators were brought out quickly to help assist with the situation.

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-20231009155452

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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3. The Department investigated the allegation: Staff do not provide adequate food service. LPA reviewed current facility menu, observed food supply in kitchen, and conducted interviews. LPA observed the facility to have proper food supply with food from all the different food categories. LPA observed the menu to have a proper variety of food available to residents.

4. The Department investigated the allegation: Resident Council is ran by facility staff. LPA conducted interviews with staff and residents. Interviewees stated which residents were in charge of the Resident Council, LPA attempted multiple times to interview members of the Resident Council which were unsuccessful.

5. The Department investigated the allegation: Staff do not provide activities to residents in care. LPA reviewed the activities calendar which had different activities listed throughout the month. LPA interviewed staff and residents. Interviewees verified there was one time during the month activities were cancelled due to a situation that took place that day with the activities director.

After conducting interviews, observing the facility, and record reviews the LPA found there is not 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 allegations are 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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