355201055-1-23-2026-24-AS-SMOA-DQQNFL-20260127092543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 355201055
Report Date: 01/20/2026
Date Signed: 01/23/2026 02:13:05 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
01/09/2026 and conducted by Evaluator Vadim Gorban

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20260109151542

FACILITY NAME:	WHISPERING PINES INN, LLC		FACILITY NUMBER:	355201055
ADMINISTRATOR:	PARK,CHARLES & MAE		FACILITY TYPE:	740
ADDRESS:	476 LOS VIBORAS ROAD		TELEPHONE:	(831) 636-9620
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	36	CENSUS: 15	DATE:	01/20/2026
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Administrator Charles Park		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not respond to a resident's pull cord in a timely manner.
Staff did not report an incident to licensing.

INVESTIGATION FINDINGS:

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On 01/20/2026, Licensing Program Analyst (LPA) V Gorban conducted subsequent complaint inspection. LPA met with administrator. The purpose of this visit is to deliver the findings of the investigation completed by the Department.
During the visit, LPA conducted health and safety tour.
Allegation: Staff did not respond to a resident's pull cord in a timely manner. Based on staff and residents interviews no concerns regarding call light response time. 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 did not report an incident to licensing. Based on records reviews and interviews no falls for R1 reported or recorded. 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 provided, report signed and copy of this report provided to administrator for facility records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

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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