547201356-4-10-2023-24-AS-SMOA-CQUL2P-20230413082236

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547201356
Report Date: 04/10/2023
Date Signed: 04/10/2023 01:30:11 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
01/12/2023 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20230112092851

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: 109	DATE:	04/10/2023
		UNANNOUNCED	TIME BEGAN:	09:22 AM
MET WITH:	Administrator Lenette Otero-Gross		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff is causing harm to a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) K. Kaur conducted a subsequent complaint inspection to deliver findings. LPA met with Administrator Lenette Otero-Gross and Health and Wellness Director Megan Mike and explained the purpose of the visit and reviewed the elements of the allegation. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on interviews conducted and documents reviewed no incident was found that showed evidence of staff causing harm to resident in care.

Based on the interviews conducted, the allegations listed above 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: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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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