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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247209172
Report Date: 11/18/2024
Date Signed: 11/18/2024 07:02:45 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
08/12/2024 and conducted by Evaluator Brianna Miranda
COMPLAINT CONTROL NUMBER: 24-AS-20240812083531
FACILITY NAME:VALLEY SPRING MEMORY CAREFACILITY NUMBER:
247209172
ADMINISTRATOR:REYNAGA, ELIZABETHFACILITY TYPE:
740
ADDRESS:555 MILLER LANETELEPHONE:
(209) 710-4783
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:50CENSUS: 26DATE:
11/18/2024
UNANNOUNCEDTIME BEGAN:
05:43 PM
MET WITH:Executive Director Krista WillsonTIME COMPLETED:
06:30 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Resident sustained an unexplained injury while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/18/24 Licensing Program Analyst (LPA) B. Miranda 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 and met with Executive Director (ED) Krista Willson and Administrator (AD) Elizabeth Reynaga.

1. The Department investigated the allegation: Resident sustained an unexplained injury while in care. LPA conducted multiple interviews with residents, staff members, and third parties. Interviewees did not recall a resident sustaining an unexplained injury while in care.

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 allegation is unsubstantiated.

Exit interview was conducted and a copy of this report LIC9099 was provided to Executive Director (ED) Krista Willson and Administrator (AD) Elizabeth Reynaga.


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: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
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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