547208956-1-18-2024-24-AS-BCHN-D2PPD6-20240222101302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547208956
Report Date: 01/17/2024
Date Signed: 01/18/2024 03:13:21 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
01/16/2024 and conducted by Evaluator Brianna Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240116162436

FACILITY NAME:	SILVER HOUSE ASSISTED LIVING		FACILITY NUMBER:	547208956
ADMINISTRATOR:	GARDINER, RACHAEL		FACILITY TYPE:	740
ADDRESS:	4439 W HAROLD AVE		TELEPHONE:	(559) 690-3986
CITY:	VISALIA	STATE: CA	ZIP CODE:	93291
CAPACITY:	6	CENSUS: 4	DATE:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	10:13 AM
MET WITH:	Administrator- Rachael Gardiner		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff did not ensure facility was free from pests

INVESTIGATION FINDINGS:

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On 01/17/2024 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct an investigation regarding the allegation(s) listed above. LPA introduced herself and explained the reason for the visit. Administrator (AD) Rachael Gardiner was contacted. Administrator arrived later.

LPA toured the bedrooms and garage of the facility with staff member on duty. LPA observed no immediate danger, facility was clean, clutter free, and odor free. LPA requested the following documents from the visit: Resident roster, staff roster with contact information, verification of current pest service. The documents and are due by the end of business day 01/19/2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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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Control Number 24-AS-20240116162436

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: SILVER HOUSE ASSISTED LIVING	FACILITY NUMBER: 547208956
	VISIT DATE: 01/17/2024

NARRATIVE

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Licensing Program Analyst (LPA) B. Miranda conducted the complaint investigation visit to the facility. During this visit LPA conducted interviews with staff and resident regarding allegation. The Department has investigated the complaint alleging: Facility Staff did not ensure facility was free from pests.
Based on observations and interviews conducted the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted and a copy of this report LIC9099 was provided to Administrator Rachael Gardiner.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna Miranda	TELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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