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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206749
Report Date: 08/23/2023
Date Signed: 08/23/2023 04:31:24 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
05/12/2023 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230512134934
FACILITY NAME:CEDARBROOK MEMORY CARE COMMUNITYFACILITY NUMBER:
107206749
ADMINISTRATOR:SARAH DENNISFACILITY TYPE:
740
ADDRESS:1425 E. NEES AVETELEPHONE:
(559) 412-2299
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:68CENSUS: 57DATE:
08/23/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Sarah DennisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff mismanaged residents medication
Staff gave resident medication from another resident
INVESTIGATION FINDINGS:
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On 08/23/2023, Licensing Program Analyst (LPA) Gorban arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. LPA met with Administrator, Sarah Dennis.
LPA toured facility with AD, reviewed resident files and discussed findings.

Allegation Staff mismanaged resident’s medication.

During the course of the investigation LPA reviewed facility records, interviewed facility staff, administrator and reporting party. Resident ran out of his medications too soon due to not ingesting them. Based on department investigation, observation and records review this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.
Report continues on the LIC90999-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
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 2
Control Number 24-AS-20230512134934
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: CEDARBROOK MEMORY CARE COMMUNITY
FACILITY NUMBER: 107206749
VISIT DATE: 08/23/2023
NARRATIVE
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Allegation: Staff gave resident medication from another resident.

During the course of investigation LPA reviewed facility records, interviewed facility staff, administrator and reporting party. Based on department investigation, observation and records reviews and staff interviews this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies issued during this inspection.

Exit interview conducted and a copy of this report was discussed and provided to Administrator, Sarah Dennis, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2