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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 207209043
Report Date: 04/02/2026
Date Signed: 04/02/2026 01:57:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
03/27/2026 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20260327132952
FACILITY NAME:CEDAR CREEK SENIOR LIVINGFACILITY NUMBER:
207209043
ADMINISTRATOR:ROBERT HUNTLEYFACILITY TYPE:
740
ADDRESS:500 N. WESTBERRY BLVD.TELEPHONE:
(559) 673-2345
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY:162CENSUS: 84DATE:
04/02/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Health and Wellness director Lupe FierrosTIME COMPLETED:
11:43 AM
ALLEGATION(S):
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Staff did not prevent resident in care from leaving the facility without supervision
INVESTIGATION FINDINGS:
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On 04/02/2026, Licensing Program Analyst (LPA) V Gorban visited the facility to commence complaint investigation. LPA met with the Health and Wellness Director Lupe Fierros stated the purpose of the visit and allowed entry. Administrator was notified of Licensing visit but was not able to attend it.

During this visit of the complaint investigation, LPA conducted a tour of the facility, interior and exterior to ensure there is no potential or immediate health and safety risk at the facility, documents were reviewed, interview conducted, and information gathered.
Allegation: Staff did not prevent resident in care from leaving the facility without supervision. Based on records reviews, resident with diagnose of dementia left facility unassisted and was located by local law enforcement and retuned to the facility therefore, the preponderance of evidence has been met, the above allegation is found to be SUBSTANTIATED. An exit interview was conducted. A copy of this report and appeal rights was provided to health and wellness director, whose signature on this form confirms receipt of this report.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
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 2
Control Number 24-AS-20260327132952
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CEDAR CREEK SENIOR LIVING
FACILITY NUMBER: 207209043
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not observed as evidenced by:
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The facility implemented 30 min staff watch on R1. The facility staff received AWOL / Elopement drill. The facility updated resident care plan. The formal report to be [provide to LPA by email by POC due date.
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Based on records reviews, resident 1 (R1) with diagnose of dementia walked out of the facility unassisted on 3/25/26, later, the same day was located by law enforcement and returned to the facility which poses health and safety 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: Alexandria Walton
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2