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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209411
Report Date: 06/13/2024
Date Signed: 07/02/2024 03:54:23 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
06/11/2024 and conducted by Evaluator David Ayers
COMPLAINT CONTROL NUMBER: 24-AS-20240611095935
FACILITY NAME:IVY PARK OF MONTEREYFACILITY NUMBER:
277209411
ADMINISTRATOR:SHEARER, KELLIEFACILITY TYPE:
740
ADDRESS:1110 CASS STREETTELEPHONE:
(818) 643-2400
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:112CENSUS: 102DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kellie Shearer - Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff did not provide adequate food service to resident in care.
INVESTIGATION FINDINGS:
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On 6/13/2024, Licensng Program Analyst (LPA) D. Ayers arrived unannounced to conduct an initial complaint inspection. LPA met with Executive Director Kellie Shearer and announced the purpose of the visit. During the visit, LPA toured the facility, conducted staff and resident interviews, and reviewed records.

Allegation: Staff did not provide adequate food service to resident in care.

During resident interviews, multiple facility residents stated that the food service is adequate. During inspection, facility perishable and nonperishable foodstuffs appeared to be adequately stored and prepared. The facility had menus priominently displayed for residents. Facility staff provide alternate meal options for every meal. 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. An exit interview was conducted with Executive Director, and a copy of the report was provided via email.
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: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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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