547200844-6-27-2024-24-AS-SMOA-D7VJUS-20240806072158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547200844
Report Date: 06/27/2024
Date Signed: 06/27/2024 01:20:53 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
03/11/2024 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20240311112418

FACILITY NAME:	PRESTIGE ASSISTED LIVING AT VISALIA		FACILITY NUMBER:	547200844
ADMINISTRATOR:	CRYSTAL GONZALES		FACILITY TYPE:	740
ADDRESS:	3120 W. CALDWELL		TELEPHONE:	(559) 735-0828
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	72	CENSUS: 35	DATE:	06/27/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	LVN Michael Herrera		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
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5
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8
9

Staff did not treat resident with dignity or respect

INVESTIGATION FINDINGS:

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2
3
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5
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7
8
9
10
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12
13

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Michael Herrera, LVN and explained the purpose of the visit and reviewed the elements of the allegations. Administrator Katrina Sinift was not available. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. No evidence was forthcoming to determine that Staff did not treat resident with dignity or respect.

Based on records review and interview of staff, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated.

Unsubstantiated

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: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

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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