<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209037
Report Date: 04/30/2024
Date Signed: 04/30/2024 02:39:53 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
01/10/2024 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20240110151439
FACILITY NAME:J&M HOMEFACILITY NUMBER:
547209037
ADMINISTRATOR:SANDOVAL, JAREDFACILITY TYPE:
735
ADDRESS:616 W LOYOLA AVETELEPHONE:
(559) 409-2803
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:4CENSUS: 4DATE:
04/30/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee Jared Sandoval TIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is left unsupervised outside
Resident is forced to wait outside for Administrator
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) K. Kaur and arrived at the facility unannounced for subsequent complaint inspection. LPA discussed the purpose of the visit and the elements of the allegations with Licensee. LPA delivered the following findings.

The Department investigated the allegations listed above. The Department conducted interviews, reviewed records. Based on, interviews conducted, and records reviewed residents were dropped off at the facility without notification to Licensee. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur; therefore, the allegations are UNSUBSTANTIATED.

Exit interview conducted with Licensee. A copy of this report was signed and given to Licensee, whose signature confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024
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 1