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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275294322
Report Date: 10/29/2024
Date Signed: 02/18/2025 02:08:07 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
10/25/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241025161754
FACILITY NAME:PARK LANE, THEFACILITY NUMBER:
275294322
ADMINISTRATOR:MONTELLANO, ANTHONYFACILITY TYPE:
740
ADDRESS:200 GLENWOOD CIRTELEPHONE:
(831) 373-0101
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:160CENSUS: 68DATE:
10/29/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Resident services Director, Eva ReiterTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility tested positive for black mold and asbestos
INVESTIGATION FINDINGS:
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This is an amended report.
On 02/11/2025, Licensing Program Analyst (LPA) V Gorban unannounced visited facility stated above to commence a complaint investigation, stated the purpose of the visit, and was allowed entry into the facility by staff. Resident services Director Eva Reiter, administrator Natasha Prunty was notified of Licensing visit and was able to attend the visit.
Allegation: Facility tested positive for black mold and asbestos. During this visit LPA toured the facility performing safety checks, also LPA interviewed staff, Administrator, and residents. Department also requested and obtained facility documents. Based on documents review mold and asbestos was observed and tested positive on the first floor, section of facility administrative offices. Repair of the affected area completed. Based on staff interviews mold was observed in offices in June of 2024 and mold remediation and asbestos abatement began in September of 2024. The preponderance of evidence standard has been met; therefore the above allegation is found to be SUBSTANTIATED.
Exit interview conducted and copy of this report with appeal rights provided for facility records.

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

DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
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-20241025161754
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 LANE, THE
FACILITY NUMBER: 275294322
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2024
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not observed as evidenced by:
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The administrator provided a proof of correction on removing mold and asbestos to LPA by email by POC due date.
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Based on observations during facility visit on 10/29/24 and files review the facility had asbestos and black mold in area administrative offices on the first floor of the facility administrative offices section.
This 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: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024
LIC9099 (FAS) - (06/04)
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