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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107208889
Report Date: 12/02/2025
Date Signed: 12/02/2025 01:13:48 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
07/25/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250725095205
FACILITY NAME:LAVERNE SENIOR CAREHOMEFACILITY NUMBER:
107208889
ADMINISTRATOR:BAUTISTA, ARLENEFACILITY TYPE:
740
ADDRESS:3194 LAVERNE AVETELEPHONE:
(559) 292-0074
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 6DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Lisa Pua,Assistant AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not provide adequate food service
Staff do not follow proper food safety practices
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/02/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct subsequent investigation and deliver complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with Assistant Administrator Lisa Pua.

During the course of the investigation, facility was toured. The facility has adequate perishable and nonperishable foods. Perishable food was observed stored in the refrigerator and freezer. Nonperishable food was observed stored in the pantry. Based on observation, the preponderance evidences has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Exit interview was conducted. A copy of this report was provided to Assistant Administrator, whose signature on this form confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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