247209172-5-17-2023-24-AS-BCHN-CSM352-20230608175601

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247209172
Report Date: 05/16/2023
Date Signed: 05/17/2023 07:55:18 AM

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
02/17/2023 and conducted by Evaluator Brianna Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230217142929

FACILITY NAME:	VALLEY SPRING MEMORY CARE		FACILITY NUMBER:	247209172
ADMINISTRATOR:	REYNAGA, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	555 MILLER LANE		TELEPHONE:	(209) 710-4783
CITY:	LOS BANOS	STATE: CA	ZIP CODE:	93635
CAPACITY:	50	CENSUS: 8	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Administrator Krista Willson		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not assist resident with obtaining medical care
Licensee does not provide staff with required training

INVESTIGATION FINDINGS:

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On 5/16/2023 at 1:25 p.m. Licensing Program Analyst B. Miranda arrived at the facility unannounced to deliver the findings for the allegations listed above. LPA introduced herself and explained the reason for the visit. Administrator (AD) Krista Willson was notified and greeted LPA at the facility.

1. The Department investigated the allegation: Staff did not assist residents with obtaining medical care. Residents, family members, third party providers, and staff were interviewed. Two of the residents, one family member, and a third-party provider who were interviewed stated that staff does assist residents with obtaining medical care when needed. AD also stated a physician comes every other week to check on residents. LPA reviewed records at the facility.

Continued report on LIC9099C

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: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20230217142929

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: VALLEY SPRING MEMORY CARE	FACILITY NUMBER: 247209172
	VISIT DATE: 05/16/2023

NARRATIVE

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2. The Department investigated the allegation: Licensee does not provide staff with required training. LPA interviewed AD and observed training material at the facility. Training material was completed in person when staff was hired. Sample of training verification was provided to LPA by AD.

There were multiple interviews conducted at the facility and over the phone. Samples of training materials were reviewed at the facility and copies of training verification was provided. LPA gathered Information from a third party provider.

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 was provided to the Administrator Krista Willson.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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