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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202747
Report Date: 09/28/2023
Date Signed: 10/03/2023 03:24:26 PM

Unfounded


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
09/18/2023 and conducted by Evaluator David Ayers
COMPLAINT CONTROL NUMBER: 24-AS-20230918170550
FACILITY NAME:DEL MONTE ASSISTED LIVING FACILITY, THEFACILITY NUMBER:
275202747
ADMINISTRATOR:SANDEEP SAINIFACILITY TYPE:
740
ADDRESS:1229 DAVID AVETELEPHONE:
(831) 375-2206
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:49CENSUS: 24DATE:
09/28/2023
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Anu Saini - LicenseeTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
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9
Facility Records
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
10
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12
13
On 9/28/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA conacted Licensee Anu Saini via telephone and announced the purpose of the visit. Licensee agreed to receive and review the report via email. 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.

This agency has investigated the complaint alleging that facility staff have falsified facility records. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. Based off of records review, no documents or reports were submitted to CCLD which contained falsified information or signatures. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. A copy of the report was provided via email for signature and exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
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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