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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 355202781
Report Date: 10/09/2024
Date Signed: 10/16/2024 08:14:59 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
07/01/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240701144717
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:
10/09/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lead RBT, Maria RomanTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff hit resident(s) in care.
Staff's behavior poses a health and safety risk to resident(s) in care.
Staff coming to work under the influence of drugs and alcohol.
INVESTIGATION FINDINGS:
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On 10/09/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility staff, lead registered Behavioral Technician (RBT) and stated the purpose of the visit. Administrator was notified of Licensing visit. During this visit LPA toured the facility inside and out and observed clients in care.

Allegation: Staff hit resident(s) in care. Based on interview, records reviews and observation during facility visites, on 7/02/24 and 10/09/24, no violent behavior observed. During staff interviews staff response is no to the allegation. Records and history review no incidents to the allegation found.

Allegation: Staff's behavior poses a health and safety risk to resident(s) in care. During the observation, interview and records review, no staff behavior violations reported by staff or incident reports, observed during the facility visit on 7/02/24 and 10/09/2024 or recorded based on records and history review.

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

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
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 2
Control Number 24-AS-20240701144717
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: BAUTISTA HOME
FACILITY NUMBER: 355202781
VISIT DATE: 10/09/2024
NARRATIVE
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Allegation: Staff coming to work under the influence of drugs and alcohol. Based on staff interviews and records review no statement of staff at work under influence of drug and alcohol was reported, observed, or reported in incident reports.

Although the above allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the alleged allegations are unsubstantiated.

Exit interview conducted, report signed and copy of this report provide to Administrator for facility records.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2