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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209241
Report Date: 12/04/2024
Date Signed: 12/05/2024 07:59:36 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
09/24/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240924084135
FACILITY NAME:PACIFIC GROVE SENIOR LIVINGFACILITY NUMBER:
277209241
ADMINISTRATOR:JESSICA SANCHEZFACILITY TYPE:
741
ADDRESS:551 GIBSON AVENUETELEPHONE:
(831) 657-5200
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:150CENSUS: 74DATE:
12/04/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator Jessica SanchezTIME COMPLETED:
12:56 PM
ALLEGATION(S):
1
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7
8
9
Staff do not ensure facility is free from pests
INVESTIGATION FINDINGS:
1
2
3
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5
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7
8
9
10
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12
13
On 12/04/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records.

Allegation: Staff do not ensure facility is free from pests. Based on records review and interviews conducted, it was determined that the facility had a problem with vermin however through review of records facility is maintaining and increased records to twice a week pest control service to resolve issue.
Based on interviews and records review, this agency has investigated the complaint alleging staff did not ensure the facility was free from pests. 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 copy of thisrpeort provide for facility records.

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

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
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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