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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247200745
Report Date: 02/23/2024
Date Signed: 02/26/2024 06:29:58 PM

Substantiated


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
01/12/2024 and conducted by Evaluator Brianna Miranda
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240112164025
FACILITY NAME:NEW BETHANYFACILITY NUMBER:
247200745
ADMINISTRATOR:FONSECA, JULIAFACILITY TYPE:
740
ADDRESS:1441 BERKELEY DRIVETELEPHONE:
(209) 827-8933
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:76CENSUS: 38DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Sister Lucinda FonsecaTIME COMPLETED:
07:30 PM
ALLEGATION(S):
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Caregivers are injecting residents with insulin.
INVESTIGATION FINDINGS:
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On 2/23/24 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. Sister Lucinda Fonseca was contacted.

Licensing Program Analyst (LPA) B. Miranda conducted the subsequent complaint investigation visit to the facility. During this visit LPA delivered investigation findings regarding the above allegations. The Department has investigated the complaint alleging: Caregivers are injecting residents with insulin. LPA interviewed R1 who was not able to answer LPA's questions. LPA spoke with staff who stated R1 was moved to memory care as a recommendation. LPA explained even as a recommendations this indicates a change of condition and there should have been a re-appraisal and new physician's report. A new physician's report was completed and sent to LPA after the LPA's initial visit on 1/19/24. The physician's report indicated the resident is not able to give their own injections.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
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 3
Control Number 24-AS-20240112164025
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: NEW BETHANY
FACILITY NUMBER: 247200745
VISIT DATE: 02/23/2024
NARRATIVE
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LPA also reviewed staff schedule which also shows there is no licensed professional at the facility after 2:00 p.m. to provide injections to R1. The MARS indicates some MedTech/Caregivers are giving R1 their injection instead of assisting with injections. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, are being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report LIC9099, LIC9099D, and appeal rights were provided to Sister Lucinda Fonseca.

SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20240112164025
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: NEW BETHANY
FACILITY NUMBER: 247200745
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2024
Section Cited
CCR
80075(b)(2)
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80075 Health Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
(2) Facility staff, except those authorized by law, shall not administer injections but staff designated by the licensee shall be authorized to assist clients with self-administration of injections as needed.
This requirement is not met as evidenced by:
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Facility has made arrangements with nursing staff to give injections. Statement will be provided to LPA.
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This requirement is not met as evidenced by: Based on observations, interviews, & record review(s), the licensee failed to only allow licensed professionals administer injectable medications. R1 was not able to communicate how they give their own injection, staff schedule indicates no licensed professional staff at the facility after 2:00 p.m., physician report states R1 is not able to administer their own injectable medication.
This poses an immediate Health, Safety or Personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3