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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 01:13:13 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
07/24/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250724084651
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):
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Staff allow resident to stay in her soiled clothing for extended periods of time
Staff do not ensure resident is provided with transfer assistance to her chair
Resident developed minor pressure injuries while in care
Staff do not ensure residents call button is operational at all times
Staff did not ensure residents personal property was safely secured
Staff do not ensure resident is spoken to in an appropriate manner
Staff handled resident in a rough manner resulting in resident sustaining a bruise
INVESTIGATION FINDINGS:
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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, interviews were conducted, and facility was toured. The residents’ call buttons are functional and operational during visit. Based on interviews conducted, staff changes residents brief throughout the day and as needed. Staff attend R1 and assist R1 in transfer. Allegation alleging staff allow resident to stay in her soiled clothing for extending periods were investigation in complaint 24-AS-20250410163831 and found to be Unsubstantiated. Based on interviews conducted and records reviewed, there was insufficient evidence to prove or disprove that staff did not ensure R1 is provided with transfer assistance to the resident’s chair, resident developed minor pressure injuries while in care, staff did not ensure resident’s personal property was safely secure, staff spoke to resident in an appropriate manner and staff handled resident in a rough manner resulting in resident sustaining a bruise. 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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