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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247206921
Report Date: 11/20/2025
Date Signed: 11/20/2025 04:03:17 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
08/21/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250821102719
FACILITY NAME:MERCED SENIOR LIVINGFACILITY NUMBER:
247206921
ADMINISTRATOR:LISA BARICEVICFACILITY TYPE:
740
ADDRESS:3420 R STTELEPHONE:
(209) 580-6124
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:93CENSUS: 83DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Administrator Lisa BaricevicTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff do not provide adequate supervision resulting in resident falling on multiple occasions.
INVESTIGATION FINDINGS:
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On 11/20/2025, Licensing Program Analyst (LPA) V Gorban conducted subsequent complaint inspection. LPA met with administrator. The purpose of this visit is to deliver the findings of the investigation completed by the Department.
During the visit, LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.
Allegation: Staff do not provide adequate supervision resulting in resident falling on multiple occasions. Based on records reviews resident fall recorded on multiple occasions with no re -appraisal follow up. The department conducted interviews and reviewed records. LPA discussed with Administrator the significance of completing pre-appraisal and needs and services plan for residents in timely manner. Re-appraisal and new needs and services is to be completed upon resident’s change of condition.
Deficiency will be cited according to Title 22 regulation on attached LIC9099-D

Exit interview conducted, report signed and copy of this report with appeal rights provided to administrator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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-20250821102719
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: MERCED SENIOR LIVING
FACILITY NUMBER: 247206921
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/24/2025
Section Cited
CCR
87463(a)
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87463 Reappraisals. (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first.. This requirement was not observed as evidenced by:
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The facility administrator will update resident re assessment and will provide updated re assessment to Licensing office to LPA by email by POC due date. Licensee will communicate reassessment with resident responsible party.
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The facility failed to record reappraisal after multiple fall of one out of 83 residents, which poses potential health and safety risk to persons 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.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2