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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202747
Report Date: 10/04/2023
Date Signed: 11/22/2023 08:43:15 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
05/24/2023 and conducted by Evaluator David Ayers
COMPLAINT CONTROL NUMBER: 24-AS-20230524150223
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:
10/04/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Anu Saini - LicenseeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Facility is short staffed
Facility food service is not adequate.
Facility does not have sufficient call system in place
INVESTIGATION FINDINGS:
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On 10/4/2023, 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.

During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. During facility inspection on 5/29/2023, 6/29/2023, 7/13/2023, and 8/10/2023, the facility had 1 medication technician and at least two caregivers on duty, as well as kitchen staff, housekeepers, and maintenance staff. Facility food service appeared to be adequate, with alternative options being presented to residents. Facility had sufficient supply of perishable and nonperishable foodstuffs. The facility call system meets requirements. 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 allegations are unsubstantiated. A copy of the report was provided to the licensee vial email and exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David AyersTELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023
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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