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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209357
Report Date: 06/11/2024
Date Signed: 06/11/2024 06:14:27 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
02/27/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240227164437
FACILITY NAME:LOTUS SENIOR LIVING CENTERFACILITY NUMBER:
107209357
ADMINISTRATOR:SHARMA, PAWANAFACILITY TYPE:
740
ADDRESS:4081 SCOTT AVE.TELEPHONE:
(559) 500-8706
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 4DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
03:08 PM
MET WITH:Main staff Beth QuilantangTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/11/2024, Licensing Program Analyst (LPA) V Gorban unannounced visited facility stated above to deliver complain findings, stated the purpose of the visit, and was allowed entry into the facility by staff Beth. Administrator (AD) was notified of Licensing visit but was not able to attend the visit. During this visit LPA toured the facility inside and out performing safety checks.
Allegation: Illegal eviction. Based on observations, interviews, and records review hospital discharged R1 even though medical treatment was active and R1 was required 24-hour medical monitoring. The Facility agreed to accept R1 back once treatment is over. Resident was voluntary moved to another facility due to required 24-hour medical observation. 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 deficiencies were cited 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: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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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