275294322-7-1-2024-24-AS-BCHN-D72NC7-20240710102014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275294322
Report Date: 07/01/2024
Date Signed: 07/01/2024 01:22:11 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
04/22/2024 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20240422111901

FACILITY NAME:	PARK LANE, THE		FACILITY NUMBER:	275294322
ADMINISTRATOR:	MONTELLANO, ANTHONY		FACILITY TYPE:	740
ADDRESS:	200 GLENWOOD CIR		TELEPHONE:	(831) 373-0101
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	160	CENSUS: 91	DATE:	07/01/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Eva Reiter - Resident Services DIrector		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff did not ensure roof was fixed timely

INVESTIGATION FINDINGS:

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On 7/1/2024, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Resident Services Director Eva Reiter and Memory Care Director Donna Lao and announced the purpose of the inspection. The purpose of this visit was to deliver the finding of the investigation completed by the Department. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. The following allegation has been determined to be Unsubstantiated:

1) Staff did not ensure roof was fixed timely: Based on observations and record review, the licensed portion of the facility was not in need of repairs to the roof. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. A copy of the report was provided to the licensee vial email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024

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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