<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547206596
Report Date: 07/02/2024
Date Signed: 07/02/2024 05:17:03 PM

Substantiated


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
03/12/2024 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20240312124816
FACILITY NAME:QUAIL PARK MEMORY CARE RESIDENCESFACILITY NUMBER:
547206596
ADMINISTRATOR:OTERO-GROSS, LENETTEFACILITY TYPE:
740
ADDRESS:5050 TULARE AVENUETELEPHONE:
(559) 624-3560
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:44CENSUS: 32DATE:
07/02/2024
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Administrator Lennette Otero-Gross and Executive Director Lauri AguilarTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not administer resident’s medications as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced for subsequent complaint inspection. LPA met with Executive Director Lauri Aguilar and discussed the purpose of the visit and the elements of the allegations. Administrator Lennette arrived a short while later. LPA delivered the following findings.

The Department investigated the allegations listed above. Based on interviews conducted and records reviewed Staff did not administer resident’s medications as prescribed. Medication audit revealed residents’ medication was not logged in the Centrally Stored Medication and Destruction Record (CSMDR). CSMDR was incomplete and missing information. R1’s Medication count revealed extra pills based on records.

The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted with Administrator, a copy of this report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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 3
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
03/12/2024 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20240312124816

FACILITY NAME:QUAIL PARK MEMORY CARE RESIDENCESFACILITY NUMBER:
547206596
ADMINISTRATOR:OTERO-GROSS, LENETTEFACILITY TYPE:
740
ADDRESS:5050 TULARE AVENUETELEPHONE:
(559) 624-3560
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:44CENSUS: DATE:
07/02/2024
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Administrator Lennette Otero-Gross and Executive Director Lauri AguilarTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not allow residents to leave the facility or have visitations
Staff did not ensure residents were provided with adequate amount of clothing and toiletries
Staff are not allowing residents to participate in decision making regarding their care and food preferences
Staff did not allow residents to have access to their personal records, phones, and personal mail
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced for subsequent complaint inspection. LPA met with Executive Director Lauri Aguilar and discussed the purpose of the visit and the elements of the allegations. Administrator Lennette arrived a short while later. LPA delivered the following findings.

The Department investigated the allegations listed above. Based on interviews conducted and records reviewed resident was allowed visitations. Due to the facility being a memory care facility residents family members have a council that has meetings/discussion regarding residents’ preferences. Residents and family members have access to residents’ records. Based on observations resident had sufficient clothing and toiletries in the room.

Based on these findings, the above allegations 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 MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
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 3
Control Number 24-AS-20240312124816
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: QUAIL PARK MEMORY CARE RESIDENCES
FACILITY NUMBER: 547206596
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2024
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
87465(a)(4) The licensee shall assist residents with self-administered medications as needed.


This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Administrator to provide a statement of intent regarding med-tech in service training and review the requirements of proper documentation to support medication pill count. Administrator to submit proof of training to CCLD by due date.
8
9
10
11
12
13
14
Medication audit revealed (R1) resident’s medication pill count had an extra 28 pills in a packet that should have been given.
8
9
10
11
12
13
14
Type B
07/09/2024
Section Cited
CCR
87465(h)(6)
1
2
3
4
5
6
7
87465(h)(6). (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained ….

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Administrator to submit completed centrally stored records by due date.
8
9
10
11
12
13
14
Medication audit reviled (R1) resident’s medication was not logged in the centrally stored list and or was incomplete.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3