275202056-5-6-2024-24-AS-BCHN-D55TGN-20240510144326

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202056
Report Date: 05/02/2024
Date Signed: 05/06/2024 03:26:05 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
11/07/2023 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20231107134042

FACILITY NAME:	CIELO VISTA		FACILITY NUMBER:	275202056
ADMINISTRATOR:	MARK CASTILLO		FACILITY TYPE:	735
ADDRESS:	806 ELM AVENUE		TELEPHONE:	(831) 674-2180
CITY:	GREENFIELD	STATE: CA	ZIP CODE:	93927
CAPACITY:	40	CENSUS: 39	DATE:	05/02/2024
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Mark Castillo - Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff do not provide resident's medication as prescribed
Staff do not safeguard resident's personal items
Staff do not ensure that resident is adequately fed
Staff do not ensure that residents are hydrated
Staff are not trained to meet resident's medical needs
Staff monitor resident's phone calls
Facility telephone is in disrepair

INVESTIGATION FINDINGS:

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On 5/2/2024, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Administrator Mark Castillo and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. 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. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegations have been determined to be Unsubstantiated:

1) Staff do not provide resident's medication as prescribed: During facility inspections on 11/9/2023 and 5/2/2024, medication administrations records were complete and accurate and medication appeared to be administered properly. During interviews, residents stated that they always receive their medication as prescribed.

-continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

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-20231107134042

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: CIELO VISTA	FACILITY NUMBER: 275202056
	VISIT DATE: 05/02/2024

NARRATIVE

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2) Staff do not safeguard resident's personal items: Facility staff maintain records of resident personal property and valuables (LIC 621). During interview, residents stated that they feel their personal items are properly safeguarded and that they have never had personal items missing or stolen.

3) Staff do not ensure that resident is adequately fed: LPA observed the facility to have an adequate supply of perishable and non-perishable food stuffs which were properly stored. Residents stated that they receive three meals and three snacks every day. Residents stated that the food was of adequate quality.

4) Staff do not ensure that residents are hydrated: LPA observed a clean water station in the facility common area. Staff stated that the water is available for resident use 24 hours a day. Residents stated that they have access to water at all times of the day and that the water is of good quality.

5) Staff are not trained to meet resident's medical needs: Based on records reviewed and interviews, facility staff training meets Title 22 requirements. Residents stated that they feel the staff are properly trained.

6) Staff monitor resident's phone calls: Staff and residents stated that they staff do not monitor residents' phone calls. In 2023, the common phone was broken due to rough handling by residents. During this time, the phone could only be utilized while on speaker phone due to the receiver being broken.

7) Facility telephone is in disrepair: In 2023, one of the facility telephones was broken due to being dropped by residents. Facility Administrator ordered new phones to replace the wall-mounted phones which were prone to damage after being dropped.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC9099 (FAS) - (06/04)

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