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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547203298
Report Date: 03/03/2025
Date Signed: 03/05/2025 09:48:42 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
07/01/2024 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240701160550
FACILITY NAME:AUTUMN OAKSFACILITY NUMBER:
547203298
ADMINISTRATOR:ONG, ANTONIO G.FACILITY TYPE:
740
ADDRESS:848 N. JAYE STREETTELEPHONE:
(559) 784-4144
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:44CENSUS: DATE:
03/03/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Matilde GarciaTIME COMPLETED:
04:27 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff restricted resident from using personal belongings.
Staff threatened resident.
Staff do not prevent residents from smoking in non-smoking areas of the facility.
Staff assaulted resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility.

During this visit LPA delivered investigation findings regarding the above allegations.The Department has investigated the complaint alleging: Facilty staff handled resident roughly. Staff restricted resident from using personal belongings, Staff threatened resident, Staff do not prevent residents from smoking in non-smoking areas of the facility, and Staff assaulted resident are UNSUBSTANTIATED. LPA observed from the investigation that the evidence of staff restricting resident from using personal belongs, threatening resident, not preventing residents from smoking in the non-smoking areas and assaulted resident was supported or consistent among all the people interviewed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
07/01/2024 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240701160550

FACILITY NAME:AUTUMN OAKSFACILITY NUMBER:
547203298
ADMINISTRATOR:ONG, ANTONIO G.FACILITY TYPE:
740
ADDRESS:848 N. JAYE STREETTELEPHONE:
(559) 784-4144
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:44CENSUS: DATE:
03/03/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Matilde GarciaTIME COMPLETED:
04:27 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff withheld resident's funds.
Licensee does not ensure the facility is in good repair.
Licensee does not ensure the facility complies with fire safety requirements.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility.
During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegation: Staff withheld resident's funds, Licensee does not ensure the facility is in good repair, and Licensee does not ensure the facility complies with fire safety requirements are UNFOUNDED. The evidence from the investigation indicated that all there were a change of payee from Tulare County Mental to a third party and there were temporary reduced and delayed of funds to residents thus caused confusion among the residents. The facility at one point had a padlock locking the southwest exit door, but was removed by facility prior and not currently locked. The facility was observed not having a leak ceiling during a tour of the facility. This agency has investigated the complaint alleging (Staff withheld resident's funds, Licensee does not ensure the facility is in good repair, and Licensee does not ensure the facility complies with fire safety requirements). We have found that the complaint was unfounded, therefore we have dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2