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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547201807
Report Date: 07/14/2022
Date Signed: 07/14/2022 11:32:48 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/13/2022 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220613151720
FACILITY NAME:SIERRA VILLAGE ASSISTED LIVINGFACILITY NUMBER:
547201807
ADMINISTRATOR:RENATA PUCKETTFACILITY TYPE:
740
ADDRESS:73 MOLENSTRAATTELEPHONE:
(559) 713-1911
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:22CENSUS: 11DATE:
07/14/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Renata PuckettTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was denied visitation at the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/14/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Renata Puckett.

During the course of the investigation, the Department conducted interviews and confirmed resident were permitted visitors.

Based on interviews conducted, the allegation above is UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted. A copy of this report was provided to Administrator.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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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