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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275294322
Report Date: 04/03/2025
Date Signed: 04/16/2025 08:35:50 AM

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
01/13/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250113094804
FACILITY NAME:PARK LANE, THEFACILITY NUMBER:
275294322
ADMINISTRATOR:NATASHA PRUNTYFACILITY TYPE:
740
ADDRESS:200 GLENWOOD CIRTELEPHONE:
(831) 373-0101
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:160CENSUS: 69DATE:
04/03/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Interim executive director, Jessica SanchezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Allegation: Staff did not transport resident to a medical appointment.
Allegation: Facility is not following the menu that is provided to residents in care.
INVESTIGATION FINDINGS:
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On 04/03/2025, Licensing Program Analyst (LPA) V. Gorban conducted subsequent unannounced complaint visit to deliver allegation findings. LPA explained the purpose of the visit to Jessica Sanchez and was allowed facility entry.

Allegation: Staff did not transport resident to a medical appointment. Allegation: Staff did not transport resident to a medical appointment. During complaint investigation, LPA interviewed facility staff and residents on 1/16/25. Based on staff interview, no complaint received from residents regarding transportation to medical appointment. Based on residents’ interviews, no one addressed concerns regarding transportation to medical appointments. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Report continues on attached LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
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 5
Control Number 24-AS-20250113094804
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
VISIT DATE: 04/03/2025
NARRATIVE
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Allegation: Facility is not following the menu that is provided to residents in care. During complaint investigation, department LPA interviewed facility staff and residents, toured the facility and reviewed records. On 1/16/25, during the facility kitchen tour and staff interview the menu on the list matched to the menu available for residents prepared by kitchen personnel (Italian wedding soup, mixed greens, grilled bratwurst Link, and roast beef sandwich). According to staff and resident interviews, there have been no reported concerns regarding facility food at the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, report signed and provided for facility records.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/13/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250113094804

FACILITY NAME:PARK LANE, THEFACILITY NUMBER:
275294322
ADMINISTRATOR:NATASHA PRUNTYFACILITY TYPE:
740
ADDRESS:200 GLENWOOD CIRTELEPHONE:
(831) 373-0101
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:160CENSUS: 69DATE:
04/03/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Interim executive director Jessica SanchezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
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9
Staff did not ensure that the facility is being cleaned.
Staff did not ensure that facility faucets are delivering hot water for residents in care.
Staff did not ensure that facility elevators are operable for residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
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10
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13
On 04/03/2025, Licensing Program Analyst (LPA) V. Gorban conducted subsequent unannounced complaint visit to deliver allegation findings. LPA explained the purpose of the visit to Jessica Sanchez and was allowed facility entry.

Allegation: Staff did not ensure that the facility is being cleaned. During the facility visit on 1/16/25, each floor has staff- housekeeper that cleans residents’ rooms, picks up trash and helps residents with their laundry. Facility staff-houseman is responsible for keeping main hallways and elevators clean. During facility visit on 1/16/25 downstairs bathroom had continuous water leak from the ceiling. Floors observed wet and slippery making unsafe for staff and residents. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations being cited on the attached LIC 9099-D
Report continues on attached LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20250113094804
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
VISIT DATE: 04/03/2025
NARRATIVE
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Allegation: Staff did not ensure that facility faucets are delivering hot water for residents in care. During facility tour, on 3/21/25 LPA toured the facility and observed the facility with no hot water. According to staff and plumbing services interviews, due to facility heritage structure, the main water lines are sensitive to water fluctuating pressure and temperature in different sections of the facility that may be easily damaged, causing low pressure in some areas of the facility. Based on observations the bathroom water temperature recorded above regulatory requirement, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations being cited on the attached LIC 9099-D.

Allegation: Staff did not ensure that facility elevators are operable for residents in care. One out of three elevators did not work properly during power outage resulting in resident being stuck in the elevator. On 12/20/2024, one elevator malfunctioned causing to complete stop with four residents in it. Based on interviews and record reviews no reported injuries to residents, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations being cited on the attached LIC 9099-D.

Exit interview conducted report signed and copy of this report with appeal rights provided for facility records.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20250113094804
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: 04/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/08/2025
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 by:
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The facility staff will implement staff- housekeeping schedule on consistent rotation basis to ensure facility cleanness. New schedule will be provided to LPA by email by POC due date.
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The facility failed to maintain bathroom floor clean and sanitary. Water leaks from the ceiling and wet floors created potential hazard. One out of three elevator broke down with residents stuck in it, which poses potential health and safety risk to persons in care
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Type B
04/08/2025
Section Cited
HSC
87303(e)(2)
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87303 (e) Water supplies....(2) ... Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
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The facility staff will work on implementing maintenance staff measures to ensure boiler operates and delivers water temperature in regulatory parameters. New measurs will be provide to LPA by email by POC due date.
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Based on observations facility staff failed to maintain faucet water temperature with in required regulations which 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: 04/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5