207209043-2-8-2024-24-AS-BCHN-D5CTSV-20240517145943

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 207209043
Report Date: 02/07/2024
Date Signed: 02/08/2024 06:33:42 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
01/25/2024 and conducted by Evaluator Brianna Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240125103121

FACILITY NAME:	CEDAR CREEK SENIOR LIVING		FACILITY NUMBER:	207209043
ADMINISTRATOR:	ELDRIDGE, KIMBERLY		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:	02:12 PM
MET WITH:	Executive Director- Kelly Reynolds & Administrator Kimberly Elderidge		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Ventilation returns in the hallways are filthy
Kitchen nutrition is poor
Activities canceled & not enough for residents to do
Tables not being sanitized
Kitchen staff not wearing hair nets or masks during food prep
Facility had no certified drivers in December and allowed staff to drive commercial vehicles

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: Ventilation returns in the hallways are filthy. LPA toured the facility and did not observe ventilation returns to be dirty. LPA conducted interviews from staff and residents. Interviewees stated they have not observed the ventilation returns to be dirty.

2. The Department investigated the allegation: Kitchen nutrition is poor. LPA reviewed current facility menu, observed kitchen with food supply, 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.

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-20240125103121

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: Activities canceled & not enough for residents to do. 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.

4. The Department investigated the allegation: Tables not being sanitized. On 1/25/24 LPA toured the dining area of the facility and the areas with tables. LPA observed the dining tables to be clean and set to serve the next meal. LPA conducted interviews with staff and residents. Staff stated there is procedure in place that all tables are cleaned and sanitized after every meal, there is assigned staff who clean and sanitize the tables and areas throughout the facility.

5. The Department investigated the allegation: Kitchen staff not wearing hair nets or masks during food prep. On 1/25/24 when LPA toured the kitchen of the facility which only had one staff member at the time. LPA conducted interviews with staff who stated gloves are worn while food is being prepared and served. Per Title 22 there is no specifics requiring hairnets or masks.

6. The Department investigated the allegation: Facility had no certified drivers in December and allowed staff to drive commercial vehicles. LPA conducted interviews with staff and residents. Interviewees stated the vans at the facility are bing used at this time since there is no certified driver to drive the facilities commercial vehicles.

After conducting interviews, observing the facility, and record reviews the LPA found there not to 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 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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