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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 207209043
Report Date: 07/15/2024
Date Signed: 07/28/2024 11:38:33 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
03/04/2024 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240304133818
FACILITY NAME:CEDAR CREEK SENIOR LIVINGFACILITY NUMBER:
207209043
ADMINISTRATOR:ELDRIDGE, KIMBERLYFACILITY TYPE:
740
ADDRESS:500 N. WESTBERRY BLVD.TELEPHONE:
(559) 673-2345
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:162CENSUS: 87DATE:
07/15/2024
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Executive Director- Kelly ReynoldsTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
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8
9
Staff did not prevent resident from being assaulted by another resident.
Staff did not prevent resident from being exploited.
INVESTIGATION FINDINGS:
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2
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5
6
7
8
9
10
11
12
13
On 7/15/24 Licensing Program Analysts (LPAs) B. Miranda & M. Vega arrived at the facility unannounced to deliver the finding for the allegation(s) listed above. LPA introduced herself and explained the reason for the visit. Executive Director- Kelly Reynolds was contacted and met with LPAs.

1. The Department investigated the allegation: Staff did not prevent resident from being assaulted by another resident. LPA conducted interviews and reviewed records. R1 is in the memory side of the facility, there was a disagreement between R1 and another resident. This is an isolated event.

2. The Department investigated the allegation: Staff did not prevent resident from being exploited. LPA conducted interviews and reviewed records. LPA reviewed R1's chart and did not find updated POA for medical. At this time all paperwork remains the same.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20240304133818
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: 07/15/2024
NARRATIVE
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Although the allegations 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 & LIC9099C were provided to Executive Director Kelly Reynolds.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2