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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 270708716
Report Date: 11/06/2025
Date Signed: 11/10/2025 09:23:17 AM

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
10/31/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20251031162259
FACILITY NAME:VISIONARY CARMEL-BY-THE-SEA ASSISTED LIVINGFACILITY NUMBER:
270708716
ADMINISTRATOR:CONNERS, MARGARET P.FACILITY TYPE:
740
ADDRESS:LINCOLN & 7TH STREETTELEPHONE:
(831) 624-1003
CITY:CARMELSTATE: CAZIP CODE:
93921
CAPACITY:10CENSUS: 6DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:House manager Shawniee Jackson TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff not present during night shift.
INVESTIGATION FINDINGS:
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On 11/06/2025, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced initial complaint investigation. LPA explained the purpose of visit to staff Tiera Maxwell and was allowed entry.

During the course of the investigation, LPA conducted a facility tour, interviewed administrator and client, and reviewed records.
The Department has investigated the allegation: Staff not present during night shift. Based on interviews staff confirmed that earlier this year in January no staff member was present in the facility grounds from 7AM to 8AM, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
Deficiency cited of attached LIC9099-D

Exit interview conducted, repot signed and copy of this report with appeal rights provided to staff for facility records.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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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Control Number 24-AS-20251031162259
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: VISIONARY CARMEL-BY-THE-SEA ASSISTED LIVING
FACILITY NUMBER: 270708716
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2025
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:
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The facility will provide a plan on make sure wstaff is on duty at all times, skywell to monitor staff presence and attendece. POC to be provide to LPA byemail by POC due date.
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The facility failed to ensure staff is sufficient in numbers to provide care to all residents at all times. This is poses potential health and safety risk to person 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: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2