547203298-6-2-2026-24-AS-AWAN-DNERY3-20251114122537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547203298
Report Date: 10/30/2025
Date Signed: 06/02/2026 02:23:01 PM

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
08/29/2025 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20250829085606

FACILITY NAME:	AUTUMN OAKS		FACILITY NUMBER:	547203298
ADMINISTRATOR:	ONG, ANTONIO G.		FACILITY TYPE:	740
ADDRESS:	848 N. JAYE STREET		TELEPHONE:	(559) 784-4144
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	44	CENSUS: 2	DATE:	10/30/2025
		UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Lisa Ong		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

“This report is being amended to update the reporting manager.”

Staff engages in various forms of physical abuse with resident in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/30/2025, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with the Licensee.
During the course of the investigation, LPA reviewed records, conducted a facility tour and interviewed residents and staff.
It was determined that the above allegations: Staff engages in various forms of physical abuse with resident in care is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Licensee. Report signed on-site.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025

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 1