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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547204112
Report Date: 07/17/2023
Date Signed: 07/17/2023 11:21:08 AM

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
04/14/2023 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20230414084230
FACILITY NAME:SOCIAL VOCATIONAL SERVICES, VISALIA #2FACILITY NUMBER:
547204112
ADMINISTRATOR:THEADOSIA JOHNSONFACILITY TYPE:
775
ADDRESS:3140 WEST CALDWELL AVENUETELEPHONE:
(559) 735-0938
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:75CENSUS: 65DATE:
07/17/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Theadosia JohnsonTIME COMPLETED:
11:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client sustained injury due to staff neglect
Staff did not provide client with medical attention
Staff are not meeting clients diapering needs
Staff are not properly trained to provide care for clients
Staff are not able to meet clients’ needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
The Department conducted interviews and reviewed records. Records of In-Service training for Hoyer Lift and Incontinence Care for staff who assist clients with brief changes were reviewed. Facility Administrator/Director denied that there were incidents of R1 referenced in the complaint requiring body checks for any marks/redness. The allegations are Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023
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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