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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209377
Report Date: 08/15/2024
Date Signed: 08/15/2024 09:46:01 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
05/03/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240503104314
FACILITY NAME:BURLINGTON, THEFACILITY NUMBER:
157209377
ADMINISTRATOR:GIBSON, KALAFACILITY TYPE:
740
ADDRESS:13 SYCAMORE DRTELEPHONE:
(415) 810-0145
CITY:WOFFORD HEIGHTSSTATE: CAZIP CODE:
93285
CAPACITY:21CENSUS: 18DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Administrator Kala Gibson via telephone and Facility Manager Ashley BellTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not comply with basic service requirements
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/15/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegation. LPA introduce self, stated the purpose of the visit, and met with Facility Manager Ashley Bell. Staff and LPA attempted to reach Licensee Anthony Barbato. Administrator Kala Gibson was called via telephone. LPA delivered findings to Administrator via telephone and Facility Manager.

During the course of the investigation, LPA conducted interviews. A food bank organization was contacted and provided information to the residents at the facility. No resident had signed up and received any food assistances form the program. Therefore, based on the interviews conducted, the preponderance of evidence standard has not been met, the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted via telephone with Administrator and Facility Manager. A copy of this report was provided to the Facility Manager, whose signature on this report confirms receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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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