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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107207113
Report Date: 01/17/2025
Date Signed: 01/17/2025 01:21:10 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
10/22/2024 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20241022092231
FACILITY NAME:BONAVENTE HOME FOR THE ELDERLY #2FACILITY NUMBER:
107207113
ADMINISTRATOR:BONAVENTE, NIDAFACILITY TYPE:
740
ADDRESS:6097 HARRISONTELEPHONE:
(559) 313-9052
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 6DATE:
01/17/2025
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Designee, Leticia AldanaTIME COMPLETED:
11:38 AM
ALLEGATION(S):
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Staff are not distributing residents P&I monies timely
There is not enough food at the facility to meet residents needs
Staff are not providing snacks to residents in care
Staff are not providing residents their clothing allowance timely
Staff do not meet the medical/mental health needs of residents
INVESTIGATION FINDINGS:
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On 1/17/25 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced complaint visit. Visit is being conducted to deliver complaint findings. LPA met with Direct Care Staff (Designee), Leticia Aldana. LPA completed tour of facility inside and out. A health and safety check on residents in care. 1 resident present during time of visit. Resident observed in living room.

During the investigation documentation was requested and reviewed (Resident roster, staff roster with contact information, staff schedule for October 2024, physician’s reports, SIRs for residents in the month of Sept/October 2024, needs and service plans) and completed interviews. During review of P & I record, it was observed that long periods (2 weeks +) of time passed before residents received their funds. Interview disclosed that clothing allowances were not being provided in a timely manner. During review of the facility resources, it was observed that the facility did not provide an electronic device for residents to have video appointments with their physicians.

CONT...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
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 4
Control Number 24-AS-20241022092231
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: BONAVENTE HOME FOR THE ELDERLY #2
FACILITY NUMBER: 107207113
VISIT DATE: 01/17/2025
NARRATIVE
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CONT...

LPA requested receipts for groceries that the Licensee did not supply. LPA observation of food in the refrigerator and snacks for the residents showed the residents were not being provided with sufficient food/snacks. The preponderance of evidence standard has been met in the allegations listed above. The allegations are SUBSTANTIATED. Deficiencies cited per Title 22.

Exit interview completed with Designee, Leticia. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20241022092231
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: BONAVENTE HOME FOR THE ELDERLY #2
FACILITY NUMBER: 107207113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/18/2025
Section Cited
HSC
1569.319(b)(1)
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(b) A licensee shall ensure the following requirements are met in providing any internet access device for resident use: (1) The device shall be available in a manner that allows a resident to access it for discussion of personal or confidential information with a reasonable level of personal privacy.
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Administrator stated a device will be purchased and provided to the residents. A receipt will be provided as proof of correction.
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This requirement is not met as evidenced by:
Based on LPA observation, the licensee did not comply with the section cited above in that the facility has a computer in the living room that does not have a camera and is inaccessible to residents. Facility does not have a device for resident use. This poses an immediate health, safety or personal rights risk to persons in care.
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Type A
01/18/2025
Section Cited
CCR
87555(a)
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a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Designee stated food was ordered today and will be delivered to the facility between 1-2 pm. Copy of receipt and check list will be provided to CCL by POC date.
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This requirement was not met as evidence by:
LPA observation of food stored in the refrigerator. Residents do not have the required food source. This poses a potential health, safety and or personal rights risk to residents in care.
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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.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20241022092231
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: BONAVENTE HOME FOR THE ELDERLY #2
FACILITY NUMBER: 107207113
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2025
Section Cited
CCR
87217(h)
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87217 Safeguards for Resident Cash, Personal Property, and Valuables
(h) Immediately upon admission, residents' cash resources entrusted to the licensee and not kept in the licensed facility shall be deposited in any type of bank, savings and loan or credit union account, which is maintained separate from the personal or business accounts of the licensee, provided that the account title clearly notes that it is residents' money and the resident has access to the money upon demand to the licensee.
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Per Designee a plan of correction will be discussed with the Licensee and Administrator. This plan will be sent to CCL in writting by POC date.
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This requirement was not met as evidence by: Based on LPA observation, the licensee did not comply with the section cited above in that residents do not have personal accounts and money is being comingled. Facility staff is not providing P&I and clothing allowance money to residents in a timely manner. This poses a potential health, safety and or personal rights risk to persons in care.
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Type B
01/27/2025
Section Cited
CCR
87555(b)(3)
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87555 General Food Service Requirements
(b) The following food service requirements shall apply:
(3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician.
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Designee stated food was ordered today and will be delivered to the facility between 1-2 pm. Copy of receipt and check list will be provided to CCL by POC date.
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This requirement was not met as evidence by: LPA observation of limited snacks (3 pks of cookies) only being available to residents in care.
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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.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4