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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209193
Report Date: 01/06/2024
Date Signed: 01/06/2024 12:33:36 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
08/21/2023 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20230821091710
FACILITY NAME:MAGNOLIA PARK ASSISTED LIVINGFACILITY NUMBER:
547209193
ADMINISTRATOR:RAMOS, MESHELLFACILITY TYPE:
740
ADDRESS:2950 E. DOUGLAS AVETELEPHONE:
(559) 625-6001
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:59CENSUS: 20DATE:
01/06/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Resident Care Director Sandra GuadarramaTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff do not ensure that residents’ diapering needs are met.
Staff leaves residents unattended for extended periods of time.
Residents sustained pressure injuries due to staff neglect.
Uncleared staff works in the facility.
INVESTIGATION FINDINGS:
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The Department conducted interviews and reviewed records. Interviews conducted and medical records reviewed stated that R1 was left with feces all over his body and left on the floor after a fall for more than thirty minutes. LPAs conducted interviews and confirmed that S1 who is not fingerprinted cleared and working at the facility. LPA reviewed medical records that confirmed residents had pressure injuries. Based on the interviews conducted and records reviewed, the above allegations are Substantiated.

Citations are issued per CCR codes Title 22. The allegations regarding Staff do not ensure that residents’ diapering needs are met, Residents sustained pressure injuries due to staff neglect, and Staff leave residents unattended for extended periods of time issued on this date under complaint number 24-AS-20230711085250. Civil Penalty Assessed based on fingerprint clearance. Exit interview was conducted and Appeal Rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024
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 3
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
08/21/2023 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20230821091710

FACILITY NAME:MAGNOLIA PARK ASSISTED LIVINGFACILITY NUMBER:
547209193
ADMINISTRATOR:RAMOS, MESHELLFACILITY TYPE:
740
ADDRESS:2950 E. DOUGLAS AVETELEPHONE:
(559) 625-6001
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY:59CENSUS: 20DATE:
01/06/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Resident Care Director Sandra GuadarramaTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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9
Staff do not ensure residents are adequately fed.
Staff did not seek timely medical attention for a resident.
Staff smoke in non-smoking areas.
INVESTIGATION FINDINGS:
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The Department conducted interviews and reviewed records. Staff interviewed denied that residents are not fed. Call for services documents that emergency services were called for residents. LPA did not observe staff smoking in the facility. The allegations are Unsubstantiated. Exit interview was conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20230821091710
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: MAGNOLIA PARK ASSISTED LIVING
FACILITY NUMBER: 547209193
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/07/2024
Section Cited
CCR
87355(b)
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87355(b) Criminal Record Clearance- Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption.

This requirement was not met as evidenced by:
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Deficiencies/POC will be addressed during NCC meeting.
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Based on interviews conducted S1 was observed at the facility without fingerprint clearance.
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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.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3