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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206937
Report Date: 02/13/2023
Date Signed: 02/16/2023 02:08:15 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
11/16/2022 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221116110027
FACILITY NAME:BACKER SENIOR CAREHOMEFACILITY NUMBER:
107206937
ADMINISTRATOR:BAUTISTA, ARLENEFACILITY TYPE:
740
ADDRESS:9127 N BACKER AVETELEPHONE:
(559) 721-5483
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 6DATE:
02/13/2023
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Arlene Bautista, AdminnistratorTIME COMPLETED:
10:54 AM
ALLEGATION(S):
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Staff confiscated resident's personal item.
Staff forcing residents to go to bed.
Staff forcing resident to shower
INVESTIGATION FINDINGS:
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On 2/13/2023 Licensing Program Analyst (LPA) V Gorban visited unanoused facility stated above to deliver findings. LPA met with Administrator Arlene Bautista And Licensee LIsa Pua.
The Department has investigated the complaint alleging:
Staff confiscated resident’s personal item. Item was requested to be taken by family member due to residents call to family at night. Based on the interviews conducted and/or records review 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.

Staff forcing resident to go to bed. Resident was offered to go to bed instead of requested smoking outside at night. House Rules prohibited smoking on the facility premises past 6pm. Based on the interviews conducted and/or records review 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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-20221116110027
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: BACKER SENIOR CAREHOME
FACILITY NUMBER: 107206937
VISIT DATE: 02/13/2023
NARRATIVE
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Staff forcing resident to shower. Resident is fall risk/ unstable and requires staff standby near, in the bathroom, behind the shower curtain while resident showers. Based on the interviews conducted and/or records review 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 conducted . No citations issued on this visit. Copy of this report printed and left with the Administrator for facility records.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2