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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 355202781
Report Date: 12/12/2023
Date Signed: 12/14/2023 08:39:22 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
09/20/2023 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20230920111826
FACILITY NAME:BAUTISTA HOMEFACILITY NUMBER:
355202781
ADMINISTRATOR:MITCHELL GUEVARAFACILITY TYPE:
737
ADDRESS:777 OLYMPIATELEPHONE:
(831) 818-7981
CITY:SAN JAUN BAUTISTASTATE: CAZIP CODE:
95045
CAPACITY:4CENSUS: 4DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
12:25 AM
MET WITH:Director of Operations, David Sandhu TIME COMPLETED:
01:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure resident's cash resources are adequately logged.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/12/2023 at 12:00 p.m. Licensing Program Analyst (LPA) V. Gorban arrived at the facility unannounced to deliver finding fo the allegation listed above. LPA met with the Director of Operations, David Sandhu and stated the purpose of the visit.

LPA toured the facility inside and out to perform a safety check.

Allegation: Staff does not ensure resident's cash resources are adequately logged.
LPA interviewed Administrator, facility staff, and clients and reviewed facility files in regard to allegation.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted, a copy of this report LIC9099 was provided to David Sandhu for facility records.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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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