547208809-3-21-2025-24-AS-SMOA-DFTPXE-20250417114209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547208809
Report Date: 03/21/2025
Date Signed: 03/21/2025 03:39:13 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
01/08/2025 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20250108093803

FACILITY NAME:	PARK VISALIA ASSISTED LIVING		FACILITY NUMBER:	547208809
ADMINISTRATOR:	AMANDA KELSEY		FACILITY TYPE:	740
ADDRESS:	3939 WEST WALNUT AVENUE		TELEPHONE:	(559) 625-3388
CITY:	VISALIA	STATE: CA	ZIP CODE:	93277
CAPACITY:	110	CENSUS: 73	DATE:	03/21/2025
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Executive Director/ Administrator Amanda Kelsey		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident sustained pressure ulcer due to neglect

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 conducted and records reviewed the facility followed the following plan of care for Resident’s (R1) Care. Resident was bedbound and already getting frequent checks and rotation due to incontinence. Despite frequent rotation the resident developed pressure ulcer sometime around 11/2024 at which point Home Health was initiated by doctor’s orders. Home Health provided wound care while facility continued medication administration for wound and continued checks and rotation.

Based on observation and interview of staff, 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: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

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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