547200844-7-30-2024-24-AS-SMOA-D93SMB-20240913135941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547200844
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:14:09 PM

Substantiated

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
04/02/2024 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20240402101858

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT VISALIA		FACILITY NUMBER:	547200844
ADMINISTRATOR:	SINIFT, KATRINA		FACILITY TYPE:	740
ADDRESS:	3120 W. CALDWELL		TELEPHONE:	(559) 735-0828
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	72	CENSUS: 32	DATE:	07/30/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator Katrina Sinift and Regional Director Gary Allinger		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident sustained injuries due to lack of staff care and supervision.
Facility is not adhering to resident's Admission Agreement.
Staff are not adequately trained.

INVESTIGATION FINDINGS:

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On this date, Licensing Program Analyst (LPA) K. Kaur, Licensing Program Manager (LPM) S. Moua, and Regional Manager (RM) B. White met with Katrina Sinift, Administrator and Gary Allinger Regional Director. The above allegations were discussed and findings were delivered.

The Department conducted interviews and reviewed records. Based on the interviews conducted and records reviewed, the resident sustained multiple fractures after staff failed to abide by R1’s care plan and the resident fell. Based on interviews conducted, staff admitted to failing to abide by R1’s care plan and continues to conduct one-person assist. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report to the facility, if any.

Citations are issued per Title 22 on the attached LIC 9099D. Appeal rights were given and exit interview was conducted.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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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Control Number 24-AS-20240402101858

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: PRESTIGE ASSISTED LIVING AT VISALIA	FACILITY NUMBER: 547200844
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/30/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/31/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements – General - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	POC – Discussed during the NCC.
	8 9 10 11 12 13 14	Based on the interviews conducted and records reviewed, R1 sustained multiple fractures after staff failed to abide by R1’s care plan and fell, which poses an immediate health and safety risk to the residents in care.	8 9 10 11 12 13 14
Type A 07/31/2024 Section Cited CCR 87411(d)(3)	1 2 3 4 5 6 7	87411(d)(3) Personnel Requirements – General - Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	POC – Discussed during the NCC.
	8 9 10 11 12 13 14	Based on the interviews conducted and records reviewed, staff were not trained on two person transfers of R1, which poses an immediate health and safety risk.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20240402101858

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: PRESTIGE ASSISTED LIVING AT VISALIA	FACILITY NUMBER: 547200844
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/30/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/31/2024 Section Cited CCR 87507(f)	1 2 3 4 5 6 7	87507(f) Admission Agreements - The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	POC – Discussed during the NCC.
	8 9 10 11 12 13 14	Based on the records reviewed and interviews conducted, staff failed to abide by the resident’s care plan of providing 2 person transfers for R1, which poses a potential health and safety risk.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC9099 (FAS) - (06/04)

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