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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547208883
Report Date: 05/31/2023
Date Signed: 05/31/2023 04:10:44 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
01/24/2023 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230124162623
FACILITY NAME:PEOPLE'S CARE AVENUE 344FACILITY NUMBER:
547208883
ADMINISTRATOR:SMITH, BILLIEJEANFACILITY TYPE:
738
ADDRESS:14453 AVENUE 344TELEPHONE:
(909) 287-3557
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:4CENSUS: 1DATE:
05/31/2023
UNANNOUNCEDTIME BEGAN:
02:48 PM
MET WITH:Kristin Ennis, AdministratorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Staff inappropriately restrained residents.
INVESTIGATION FINDINGS:
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On 5/31/23 at 2:48 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. LPA explained reason for inspection and was granted entry. LPA met with Administrator (ADM) Kristin Ennis.

LPA reviewed records. During the course of the investigation, LPA reviewed records and conducted interviews. Based on records review and interviews conducted, LPA found that staff inappropriately restrained residents. On 1/23/23, staff placed R1 in a CPI hold and continued to restrain R1 after R1 was no longer considered an immediate threat to self or others. Records also indicate that on 12/8/22, staff placed R2 in a CPI hold and continued to restrain R2 after R2 was no longer considered an immediate threat to self or others. Review of records indicate that as a result of the 12/8/22 incident, facility was issued a Corrective Action Plan by Central Valley Regional Center. The above allegation is substantiated.

A deficiency is being cited based on LPA's interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9099D. *Continue on LIC9099-C.*
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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
Control Number 24-AS-20230124162623
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: PEOPLE'S CARE AVENUE 344
FACILITY NUMBER: 547208883
VISIT DATE: 05/31/2023
NARRATIVE
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*Continued from LIC9099.*

An exit interview was conducted and a Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and left with Administrator Kristin Ennis, whose signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20230124162623
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: PEOPLE'S CARE AVENUE 344
FACILITY NUMBER: 547208883
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2023
Section Cited
CCR
85102(a)(3)
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85102 Emergency Intervention Prohibitions ...(a) The following emergency interventions shall not be used on a client: (3) Manual restraint or seclusion when imminent risk of serious physical harm to self or others is no longer present;

This requirement was not met as evidenced by:
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Facility completed a 16-hour In-Service training for all staff on the topic of Crisis Prevention Institute (CPI) between the dates of 5/4/23-5/12/23, given by Quality Assurance Specialist. Administrator provided proof of training. POC cleared during inspection.
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On 1/23/23, staff placed R1 in a CPI hold and continued to restrain R1 after R1 was no longer considered an immediate threat to self or others. Records also indicate that on 12/8/22, staff placed R2 in a CPI hold and continued to restrain R2 after R2 was no longer considered an immediate threat to self or others. Review of records indicate that as a result of the 12/8/22 incident, facility was issued a Corrective Action Plan by Central Valley Regional Center. This poses a potential health, safety, or personal rights risk to residents in care.
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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: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3