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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209425
Report Date: 11/04/2025
Date Signed: 11/04/2025 01:19:50 PM

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
10/29/2025 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20251029100138
FACILITY NAME:AMERICAN SENIOR LIVINGFACILITY NUMBER:
157209425
ADMINISTRATOR:JUAREZ, LINA F DIAZFACILITY TYPE:
740
ADDRESS:9003 DROVERS RUN RDTELEPHONE:
(661) 493-8209
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 5DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator Lina Juarez and Licensee Shervin MohammadiTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff did not treat resident with respect
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) M. Yang conducted initial complaint investigation. LPA introduce self, stated the purpose of the visit, and met with Licensee/Administrator (L1) Lina Juarez. Licensee (L2) Shervin Mohammadi arrived shortly. LPA discussed complaint and delivered complaint findings to Licensees.

During the course of the investigation, the Department conducted interviews and reviewed records. L1 confirmed making comments regarding R1. Based on interviews conducted, staff alleged not treating resident with respect, the preponderance of evidences has been met. Therefore, the above allegation is found to be SUBSTANTIATED. An exit interview was conducted. A copy of this report and appeal rights were provided to Licensee/Administrator, whose signature on this form confirms receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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-20251029100138
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: AMERICAN SENIOR LIVING
FACILITY NUMBER: 157209425
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1 (a)(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.

This requirement is not met as evidenced by:
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Licensee will review Personal Rights regulation and submit a written statement of understanding and ensuring residents’ personal rights will be met. Written statement will be submitted to the Fresno CCL office by POC due date 11/05/25.
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Based on interviews conducted, the licensee did not comply with the section cited above Licensee/ Administrator confirmed making comments regarding R1 of R1’s behavior, which poses/posed an immediate 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: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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
10/29/2025 and conducted by Evaluator Mai Yang
COMPLAINT CONTROL NUMBER: 24-AS-20251029100138

FACILITY NAME:AMERICAN SENIOR LIVINGFACILITY NUMBER:
157209425
ADMINISTRATOR:JUAREZ, LINA F DIAZFACILITY TYPE:
740
ADDRESS:9003 DROVERS RUN RDTELEPHONE:
(661) 493-8209
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 5DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator Lina JuarezTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff did not properly transfer resident, resulting in an injury.
Staff did not assist resident with mobility needs in a timely manner.
INVESTIGATION FINDINGS:
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On this date, Licensing Program Analyst (LPA) M. Yang conducted initial complaint investigation. LPA introduce self, stated the purpose of the visit, and met with Licensee/Administrator (L1) Lina Juarez. Licensee (L2) Shervin Mohammadi arrived shortly. LPA discussed complaint and delivered complaint findings to Licensees.

During the course of the investigation, interviews were conducted, records were reviewed, and the facility was toured. Staff responses to residents and trained to properly transfer residents in and out of wheelchairs. It was disclosed that R1 had a fall with staff present and additional staff responded to assist in lifting R1 to walker. Based on records reviewed and interviews conducted, the preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. Exit Interview was conducted. A copy of this report was provided to Licensee/Administrator, 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: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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