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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209230
Report Date: 08/21/2025
Date Signed: 08/21/2025 12:19:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
08/11/2025 and conducted by Evaluator Jacques Leffall
COMPLAINT CONTROL NUMBER: 24-AS-20250811100753
FACILITY NAME:STANFORD COTTAGE ASSISTED LIVINGFACILITY NUMBER:
107209230
ADMINISTRATOR:VASQUEZ, MARTHAFACILITY TYPE:
740
ADDRESS:2202 STANFORD AVETELEPHONE:
(559) 375-1687
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator: Martha VasquezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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9
Facility staff are harassing resident

Facility staff do not ensure resident's dietary needs are met
INVESTIGATION FINDINGS:
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On 8/19/25 at 9:30 am Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and investigate above allegation and delivered findings. LPA met with Administrator (A1) Martha Vasquez and stated purpose of the visit.

The Department reviewed records and conducted interviews with staff, residents and facility Administrator. The Department toured the facility and checked all food supply. Staff was preparing lunch at 11:00am. A1 provided LPA a monthly menu along with a 30 day Activity Calendar.

Based on interviews that were conducted residents stated there are no issues with the food and staff are following dietary needs. LPA observed a menu and an adequate supply of perishable and non-perishable food. A1 has provided records, progress notes and Physician's reports that includes R1's behaivors, mental impairments and disabilities.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued.

Exit interview conducted. A copy of this report was provided to Administrator whose signature confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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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