247209172-11-18-2024-24-AS-BCHN-DCA574-20241224184141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247209172
Report Date: 11/18/2024
Date Signed: 11/18/2024 07:05:08 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
11/15/2024 and conducted by Evaluator Brianna Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20241115122005

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: 26	DATE:	11/18/2024
		UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:	Executive Director Krista Willson		TIME COMPLETED:	07:45 PM

ALLEGATION(S):

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Staff caused injuries to resident in care
Staff handled resident in a rough manner
Staff are not meeting resident's diapering needs
Facility is not kept clean
Facility is not kept free of pests
Staff refused to shower resident in care

INVESTIGATION FINDINGS:

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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: Staff caused injuries to resident in care. LPA conducted multiple interviews with residents, staff members, and third parties. Interviewees did not state resident injuries were caused by staff members.

2. The Department investigated the allegation: Staff handled resident in a rough manner. LPA conducted multiple interviews with residents, staff members, and third parties. Interviewees stated they did not witness residents being handled by staff in a rough manner.

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: 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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Control Number 24-AS-20241115122005

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: 11/18/2024

NARRATIVE

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3. The Department investigated the allegation: Staff are not meeting resident's diapering needs. LPA conducted multiple interviews with residents, staff members, and third parties. Interviewees stated residents are changed after every meal, every two hours, or as needed. Some interviewees stated the residents are checked every hour.

4. The Department investigated the allegation: Facility is not kept clean. LPA conducted multiple interviews with residents, staff members, and third parties. Interviewees stated facility is always kept very clean. LPA toured the facility and did not find the facility to be kept unclean.

5. The Department investigated the allegation: Facility is not kept free of pests. LPA conducted multiple interviews with residents, staff members, and third parties. Interviewees stated there was one baby mouse found at the facility and it was removed immediately. Interviewees stated there is a monthly exterminator that services the facility. LPA toured the facility and did not find any pest debris or droppings.

6. The Department investigated the allegation: Staff refused to shower resident in care. LPA conducted multiple interviews with residents, staff members, and third parties. Interviewees stated residents are showered 2-3 times a week. If a resident does not want to shower the staff tried different methods to get the resident to shower and if the residents request a shower they are given a shower.

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 and LIC9099D were provided to Executive Director (ED) Krista Willson and Administrator (AD) Elizabeth Reynaga.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 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

LIC9099 (FAS) - (06/04)

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