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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209489
Report Date: 11/26/2025
Date Signed: 11/26/2025 09:03:34 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
08/22/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250822153020
FACILITY NAME:COTTAGES OF CARMELFACILITY NUMBER:
277209489
ADMINISTRATOR:ESTRELLADO, JULE MAYFACILITY TYPE:
740
ADDRESS:26245 CARMEL RANCHO BLVD.TELEPHONE:
(831) 620-1800
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:78CENSUS: 56DATE:
11/26/2025
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Health services director Lillian RussellTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are not properly addressing resident’s pressure injuries
Staff are not meeting resident’s incontinence needs
Staff are not providing quality food service to residents
Staff do not respond to residents calls for help
INVESTIGATION FINDINGS:
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On 11/26/2025, Licensing Program Analyst (LPA) V Gorban conducted subsequent complaint inspection. LPA met with HSD. The purpose of this visit is to deliver the findings of the investigation completed by the Department.

During the visit, LPA conducted a tour of the facility, interior and exterior to ensure there is no potential or immediate health and safety risk at the facility.

Allegation: Staff are not properly addressing resident’s pressure injuries. Based on records review no pressure injuries observed, reported or documented. 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.

Report continues on attached LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
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
08/22/2025 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20250822153020

FACILITY NAME:COTTAGES OF CARMELFACILITY NUMBER:
277209489
ADMINISTRATOR:ESTRELLADO, JULE MAYFACILITY TYPE:
740
ADDRESS:26245 CARMEL RANCHO BLVD.TELEPHONE:
(831) 620-1800
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:78CENSUS: 56DATE:
11/26/2025
UNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Health services director Lillian RussellTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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9
Staff does not ensure resident’s room is kept clean
INVESTIGATION FINDINGS:
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On 11/26/2025, Licensing Program Analyst (LPA) V Gorban conducted subsequent complaint inspection. LPA met with HSD. The purpose of this visit is to deliver the findings of the investigation completed by the Department.
During the visit, LPA conducted a tour of the facility, interior and exterior to ensure there is no potential or immediate health and safety risk at the facility.
Allegation: Staff does not ensure resident’s room is kept clean. Based on records review resident’s (R1) room appear dirty with feces all over the room floor. Interviews conducted stated that the resident’s room had a strong smell of feces and urine stains on the carpet as well. The preponderance of evidence standard has been met; therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D

Exit interview conducted, report signed and copy of this report with appeal rights provided to HSD for facility records.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20250822153020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: COTTAGES OF CARMEL
FACILITY NUMBER: 277209489
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation. a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not observed as evidenced by:
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The facility administrator will provide Licensing office plan of correction by POC due date (12/01/2025) describing (in formal letter) the measure taken to ensure regulation followed.
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The facility staff failed to ensure to follow title 22 regulation regarding facility cleanness, which poses potential health and safety to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20250822153020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: COTTAGES OF CARMEL
FACILITY NUMBER: 277209489
VISIT DATE: 11/26/2025
NARRATIVE
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Allegation: Staff are not meeting resident’s incontinence needs. Based on staff interviews, residents are checked every two hours. Based on observation skin is intact and no redness or skin breakdown observed. 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.

Allegation: Staff are not providing quality food service to residents. Based on observations during facility visits, food were observed to be stored according to regulation standards. The facility employs CA certified nutritionist/ dietitian. No concerns from residents were reported based on interviews conducted. 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.

Allegation: Staff do not respond to residents’ calls for help. Based on interviews and records reviewed, facility employs three staff members per shift that provide care only for memory care section of the facility. Each resident room is equipped with call light system that is observed operational. 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.

Report continues on attached LIC9099-A
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4