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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 247202428
Report Date: 11/04/2025
Date Signed: 11/07/2025 03:50:05 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
06/05/2025 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20250605143848
FACILITY NAME:PARK MERCEDFACILITY NUMBER:
247202428
ADMINISTRATOR:ELINA MOILANENFACILITY TYPE:
740
ADDRESS:3050 M STREETTELEPHONE:
(209) 722-3944
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:125CENSUS: 64DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Elina MoilanenTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff caused an injury to a resident in care.
Staff did not notify resident's responsible party of an incident.
INVESTIGATION FINDINGS:
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On 11/04/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to administrator and was allowed entry.
During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records.
Allegation: Staff caused an injury to a resident in care. Based on interviews, while assisting resident (R1) with showers and dressing, S1 caused pain to R1 left hand. R1 was taken to medical facility for evaluation that revealed no injury.
Allegation: Staff did not notify resident's responsible party of an incident. Based on records review, the responsible party was notified of the incident by phone, on 6/2/25.
Although the 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.

Report continues on attached LIC9099-A


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
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
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
06/05/2025 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20250605143848

FACILITY NAME:PARK MERCEDFACILITY NUMBER:
247202428
ADMINISTRATOR:ELINA MOILANENFACILITY TYPE:
740
ADDRESS:3050 M STREETTELEPHONE:
(209) 722-3944
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY:125CENSUS: 64DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Elina MoilanenTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not follow resident's care plan.
Staff yelled at a resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/04/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to administrator and was allowed entry.
During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records.
Allegation: Staff did not follow resident's care plan. Based on interviews R1 is partially independent and required assistance with showers/bath. Based on interviews and records reviews, S1 rushed R1 and pulled R1 hand, therefore the above allegation is found to be SUBSTANTIATED.
Allegation: Allegation: Staff yelled at a resident in care. Based on records review S1 yelled at resident because R1 appear as hard of hearing and did not respond to S1 questions. Observations during interview and LPA and records review revealed that R1 has no auditory impairments, therefore the above allegation is found to be SUBSTANTIATED.
Exit interview conducted, report signed and with appeal rights provided to administrator for facility follow up and records.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
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: 2 of 3
Control Number 24-AS-20250605143848
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: PARK MERCED
FACILITY NUMBER: 247202428
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2025
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: records review
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The facility leadership and administrator will provif ra written statement on facility new in=mplementatiosn regarding this incidnet by POC due date
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14
Based on records review and interviews S1 pulled R1 resulted in pain of R1 left wrist and left shoulder. This is poses potential health and safety risk to presons in care
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Type B
11/07/2025
Section Cited
CCR
87468.1(a)
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Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: This requitement was observed as evidenced by: records review.
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The facility leadership and administrator will provide a written statement on facility new implementations regarding this incident by POC due date
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The facility failed to follow resident care plan and yelled on resident violating R1 personal rights. This is poses potential 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: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
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: 3 of 3