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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547206600
Report Date: 08/21/2023
Date Signed: 08/21/2023 01:11:55 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
03/28/2023 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20230328154956
FACILITY NAME:WALNUT GROVE HOUSE, INC. DBA LEWIS GRAVES ARF #1FACILITY NUMBER:
547206600
ADMINISTRATOR:GARCIA, BRIANNAFACILITY TYPE:
735
ADDRESS:25401 ROAD 152TELEPHONE:
(559) 747-3319
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 4DATE:
08/21/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator in Standing Tami LevyvaTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Client's P&I funds are not being spent on client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent complaint visit. LPA met with
Administrator in Standing Tami Levyva and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on interviews conducted and records reviewed Residents P& I funds were spent on items that were not in the possession of the resident.

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.
t
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
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
03/28/2023 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20230328154956

FACILITY NAME:WALNUT GROVE HOUSE, INC. DBA LEWIS GRAVES ARF #1FACILITY NUMBER:
547206600
ADMINISTRATOR:GARCIA, BRIANNAFACILITY TYPE:
735
ADDRESS:25401 ROAD 152TELEPHONE:
(559) 747-3319
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 4DATE:
08/21/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator in Standing Tami LevyvaTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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2
3
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9
Client was left outside unsupervised for hours
Client's hygiene needs are not being met
Client is restrained
Client is forced to take medication
INVESTIGATION FINDINGS:
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9
10
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13
Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent complaint visit. LPA met with
Administrator in Standing Tami Levyva and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on interviews conducted and records reviewed the Staff and Administrator at the time of said allegation are no longer employed at the facility. No evidence could be gathered regarding allegations.

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:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
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-20230328154956
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: WALNUT GROVE HOUSE, INC. DBA LEWIS GRAVES ARF #1
FACILITY NUMBER: 547206600
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2023
Section Cited
CCR
80026(b)
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80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents (b) If such a client is accepted for or maintained in care, his/her cash resources, personal property, and valuables... shall be handled by the licensee or facility staff, and shall be safeguarded in accordance with the requirements specified in (c) through (n) below.

This requirement was not met evident by:
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Licensee to ensure residents property to be safeguarded and all future P & I funds are spent on resident.
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During records review/audit of Residents P & I funds; items that were purchased for resident were unaccounted for.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3