547201356-1-17-2024-24-AS-SMOA-D34LQA-20240306075712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547201356
Report Date: 01/17/2024
Date Signed: 01/17/2024 03:54:42 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
11/20/2023 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20231120132803

FACILITY NAME:	QUAIL PARK RETIREMENT VILLAGE, LLC		FACILITY NUMBER:	547201356
ADMINISTRATOR:	OTERO-GROSS, LENETTE		FACILITY TYPE:	740
ADDRESS:	4520 W CYPRESS AVE		TELEPHONE:	(559) 624-3500
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	175	CENSUS: 111	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Administrator Lenette Otero-Gross		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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9

Licensee does not maintain the facility in good repair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Lenette Otero-Gross and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on observation and interviews with residents no issues have been observed that require repair or attention. Interview was conducted with Resident (R1) who stated kitchen sink was repaired recently. Work order was reviewed which indiacted the order was submited and completed on 1/16/2024.

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: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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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