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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209268
Report Date: 02/13/2025
Date Signed: 02/14/2025 07:53:29 AM

Substantiated


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
12/06/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241206120554
FACILITY NAME:PRECIOUS LIFE RESIDENCES, LLCFACILITY NUMBER:
157209268
ADMINISTRATOR:CRISOSTOMO, PETROFACILITY TYPE:
740
ADDRESS:10414 BICHESTER COURTTELEPHONE:
(661) 472-9253
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 6DATE:
02/13/2025
UNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Susan Blanza, LicenseeTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not provide refund upon resident’s death.
Staff did not provide 60-day notice prior to rent increase.
INVESTIGATION FINDINGS:
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On 02/13/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit, and met with Susan Blanza, Licensee.

During the course of the investigation, the Department conducted interviews and reviewed records. R2 had paid in advance for September 2024 rent on 08/27/24. R2 had deceased on 09/27/24. R1 paid in advance for October 2024 rent on 09/26/24. Early October 2024, R1 informed L1, R1 is moving out end of October 2024. On 10/23/24, L1 informed R1’s niece of rent increase from $1500.00 to $3750.00. R1 moved out of the facility on 10/28/24. On 10/28/24, L1 refunded a check for amount of $1000.00.

Based on records reviewed and interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, is being cited on the attached Lic 9099D. An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee, whose signature confirms receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 24-AS-20241206120554
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PRECIOUS LIFE RESIDENCES, LLC
FACILITY NUMBER: 157209268
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2025
Section Cited
HSC
1569.655(a)
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HSC 1569.655 (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident…

This requirement is not met as evidenced by:
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Licensee shall submit a plan of steps that will be taken to ensure the regulation is met which will include when and how Licensee will notify residents or the resident’s representative of any rate increases by the POC due date 02/14/25.
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Based on records reviewed and interview conducted, the licensee did not comply with the section cited above. Licensee informed R1 rent adjust applied starting the same month, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
02/26/2025
Section Cited
CCR
87507(g)(5)(A)
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87507(g)(5)(A) Refund conditions. (A)Facility policy concerning refunds, including the conditions under which a
refund for advanced monthly fees will be returned in the event of a resident’s death…

This requirement is not met as evidenced by:
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Licensee agrees to submit proof of refund to Fresno CCL office by POC due date 02/26/25.
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Based on records reviewed and interview conducted, the licensee did not comply with the section cited above when
R2 made payments for September 2024 in August 2024 and deceased on 09/27/24. R1 made payments for October 2024 in September 2024 and R1 moved out of the facility on 10/27/24. L1 did not refund full refund amount after R2 deceased, which poses/posed a potential health, safety or personal rights risk to persons in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
12/06/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241206120554

FACILITY NAME:PRECIOUS LIFE RESIDENCES, LLCFACILITY NUMBER:
157209268
ADMINISTRATOR:CRISOSTOMO, PETROFACILITY TYPE:
740
ADDRESS:10414 BICHESTER COURTTELEPHONE:
(661) 472-9253
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 6DATE:
02/13/2025
UNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Susan Blanza, LicenseeTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not providing authorized representative with a copy of the admissions agreement when requested.
Staff misplacing resident’s personal belongings.
INVESTIGATION FINDINGS:
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2
3
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On 02/13/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to delivered complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with Susan Blanza, Licensee.

During the course of the investigation, records were received, interviews were conducted, and facility was toured. Interviews conducted, it was confirmed R1 received personal belongings. The department did not observe R1’s personal belongings at the facility. R1 had moved out of the facility and after the resident moved out, R1 had designated a new authorized representative who requested and received partial R1 and R2’s admission agreement. Based on observation, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to the Licensee, 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: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3