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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 207209150
Report Date: 10/25/2024
Date Signed: 10/31/2024 12:31:09 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
07/18/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240718100813
FACILITY NAME:GOLDEN YEARS RESIDENTIAL CARE HOME, THEFACILITY NUMBER:
207209150
ADMINISTRATOR:LUARES, BERNARDINOFACILITY TYPE:
740
ADDRESS:160 S 13TH STREETTELEPHONE:
(707) 235-2717
CITY:CHOWCHILLASTATE: CAZIP CODE:
93610
CAPACITY:41CENSUS: 37DATE:
10/25/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Supervisor Amber MyersTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff threatened to evict a resident in care.
Staff is not allowing a resident to wear a mask.
INVESTIGATION FINDINGS:
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On 10/25/2024, Licensing Program Analyst (LPA) V Gorban arrived at the facility unannounced to conduct a subsequent visit and met with Facility Supervisor, Ember Myers to deliver findings of above allegation. LPA explained the purpose of the visit.

Allegation: Staff threatened to evict resident in care.

During complaint investigation department reviewed facility records, interviewed staff, and residents. Based on interviews no witnesses to eviction allegation. Based on staff and residents interviews no residents work at the facility and no to denying residents to wear face mask when requested. Based on history file review no records of incidents observed. Staff interviewed on 07/23/24 denied allegation refusing face mask to residents and resident work at the facility. On 07/23/24, during residents interviewed no supportive information in regard to eviction allegation.
Report continues on attached LIC 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
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-20240718100813
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: GOLDEN YEARS RESIDENTIAL CARE HOME, THE
FACILITY NUMBER: 207209150
VISIT DATE: 10/25/2024
NARRATIVE
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Allegation: Staff is not allowing a resident to wear a mask.

Allegation: Staff is not allowing a resident to wear a mask. During complaint investigation department conducted staff and residents’ interviews. On 07/23/24 based on interviews no reports of denying mask to residents. During facility visit on the same day LPA observed face mask box at the main entrance on the table with hand sanitizer available to all.

Although the above allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.



No deficiency was cited during this visit. Exit interview conducted , report signed and copy of this report provided to Administrator for facility records.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2