275294322-8-23-2024-24-AS-BCHN-D8XVAB-20240909161539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275294322
Report Date: 08/15/2024
Date Signed: 08/23/2024 05:59:36 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
08/13/2024 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240813154344

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: 184	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Resident Services Director Eva Reitler		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Facility staff is retaliating due to complaint that was filed against facility

INVESTIGATION FINDINGS:

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On 08/15/2024, Licensing Program Analyst (LPA) V Gorban unannounced visited facility stated above to commence a complaint investigation, stated the purpose of the visit and was allowed entry into the facility by staff. Resident Services Director Eva Reitler was notified of Licensing visit and was able to attend the visit.
During this visit LPA toured the facility performing safety checks, also LPA interviewed staff, Administrator, and residents. After the tour LPA discussed the findings with the RSD.

Allegation: Facility staff is retaliating due to complaint that was filed against facility. During this visit LPA interviewed Administrator, staff and residents. Based on observation and interviews no retaliation against staff was revealed. 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

Exit interview conducted and copy of this report provided to Administrator for facility records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim Gorban	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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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