547208809-10-26-2023-24-AS-SMOA-CY7MD2-20231204083021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547208809
Report Date: 10/26/2023
Date Signed: 10/26/2023 04:47:40 PM

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
06/19/2023 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20230619145953

FACILITY NAME:	PARK VISALIA ASSISTED LIVING		FACILITY NUMBER:	547208809
ADMINISTRATOR:	MARTIN VALE		FACILITY TYPE:	740
ADDRESS:	3939 WEST WALNUT AVENUE		TELEPHONE:	(559) 625-3388
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	110	CENSUS: 77	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Executive Director, Amanda Kelsey		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident sustained severe injury due to staff neglect
Staff did not administer resident's medication
Staff did not assist resident with eating
Staff did not provide adequate food service to resident
Staff did not meet resident's laundry needs
Facility is malodorous

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Amanda Kelsey 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 and record review no incidents were documented that resulted in resident abuse or injury. Medication audit was conducted but was inclusive due to resident relocation. Resident weight records were reviewed which indicated although resident weight was at an incline recently at the time of resident admission the resident had put on weight. Facility tour was conducted and did not reveal any facility physical plant issues.
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Based on observation and interview of staff and residents, 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 Moua	TELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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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