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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209272
Report Date: 10/20/2023
Date Signed: 10/22/2023 06:55:21 AM

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
08/14/2023 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230814104419
FACILITY NAME:FRESNO GUEST HOME #18FACILITY NUMBER:
107209272
ADMINISTRATOR:KUTNERIAN, GEORGEFACILITY TYPE:
740
ADDRESS:2804 E. PALO ALTO AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 6DATE:
10/20/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Assistant Administrator, Jay Cee SandersonTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not provide residents enough food to meet their needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/20/23 Licensing Program Analyst (LPA) V Gorban visited the facility stated above to deliver findings. LPA met with Assistant Administrator Jay Cee Sanderson, explained the purpose of the visit. LPA toured facility inside and out, observed clients in care and discussed finding to allegation.

Allegation: Staff do not provide residents enough food to meet their needs

During this investigation LPA interviewed facility staff, residents, and responsible party. During interview residents stated that the facility provides substantial amounts of food to residents at all times. During this investigation LPA reviewed facility files. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.
No citations were issued during this visit.
Exit interview conducted, report signed and copy of this report provided to administrator for facility records.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
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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