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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547206666
Report Date: 08/04/2022
Date Signed: 08/04/2022 09:52:01 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
03/24/2022 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20220324092910
FACILITY NAME:KAISER SPECIALIZED RESIDENTIAL VASSARFACILITY NUMBER:
547206666
ADMINISTRATOR:ENNIS,KRISTENFACILITY TYPE:
735
ADDRESS:4224 E VASSAR AVETELEPHONE:
(559) 622-8955
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:4CENSUS: 4DATE:
08/04/2022
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Stacey Mclaughlin,AdministratorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
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5
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7
8
9
Administrator does not ensure a safe and healthful environment for residents

Staff makes racist comments to residents

Staff gets in resident's face

Staff bullies’ staff in presents of residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) V. Gorban and Licensing Program Manager (LPM) S. Moua conducted a subsequent complaint inspection. LPA met with Administrator Stacey McLaughlin and discussed the purpose of the visit. The allegations were discussed.

Facility staff and residents were interviewed. Three residents were present during the inspection and engaged in activities. Residents were observed interacting and communicating with staff. No incidents of verbal abuse or personal rights were reported to the Department. Administrator certificate is current. No safety concerns were observed during the tour.

Based on records reviewed, observation, and interviews conducted, the above allegations are Unsubstantiated. Exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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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