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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209241
Report Date: 04/10/2025
Date Signed: 04/11/2025 07:00:27 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
02/20/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250220095235
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: 77DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Sales Director Jonathan MonroeTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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garbage not being picked up
inadequate emergency lighting in the hallways
plumbing issues throughout the facility
residents reported that the construction has lasted over a year, with workers allegedly starting work before 7 AM, playing loud music and smoking marijuana
facility is not conducting quarterly fire/emergency drills as required
INVESTIGATION FINDINGS:
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On 04/10/2025, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced subsequent complaint investigation to deliver findings. LPA explained the purpose of visit to Sale Director Jonathan Monroe. Administrator, Jessica Sanchez was notified of visit via phone.

Allegation: Garbage not being picked up. The Department received and viewed photos of waste on the premises. During this inspection, LPA toured the facility and conducted interviews. During an interview with the Administrator, the Administrator stated that the facility garbage was not picked up by waste services on 1/27/25 due to nonpayment. On 1/29/25, the Administrator acquired a U-Haul truck, and facility staff loaded the garbage onto the U-Haul to remove the garbage from the facility. Based on interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D.
Repot continues on attached LIC9099-D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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-20250220095235
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: PACIFIC GROVE SENIOR LIVING
FACILITY NUMBER: 277209241
VISIT DATE: 04/10/2025
NARRATIVE
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Allegation: Inadequate emergency lighting in the hallway. During the complaint investigation, LPA conducted a facility tour with the maintenance director. During the tour, LPA discovered that the facility’s portable emergency lights were not functioning properly. When the emergency lighting was tested, the emergency lighting was non-operational and did not turn on. Based on observation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D.

Allegation: Plumbing issues throughout the facility. During this investigation, LPA toured the facility, and interviewed residents and staff. During the tour, LPA observed water damage on the walls and ceiling of the facility. Interviews revealed that the facility is having plumbing issues, and that the plumbing system is in need of repair. Based on observations and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D.

Allegation: Facility is not conducting quarterly fire/emergency drills as required. LPA conducted interviews and reviewed records. It was discovered that the facility’s last documented fire drill was conducted on 02/24/2025. Prior to this, the last fire drill was conducted on 04/20/2024. California Health and Safety code requires a fire drill to be conducted at least quarterly for each shift. Based on interviews and record review, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D.

Allegation: Residents reported that the construction has lasted over a year, with workers allegedly starting work before 7AM, playing loud music and smoking marijuana. During this investigation, LPA conducted interviews with residents. Consistent statements from residents revealed that the construction crew plays music, while repairing the facility, prior to 7:00 AM. Based on interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations, Title 22 on the attached 9099-D.

Exit interview conducted. A copy of this report and appeal rights were discussed and provided to the facility representative. Report signed on-site.

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

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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
02/20/2025 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20250220095235

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: 77DATE:
04/10/2025
ANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:TIME COMPLETED:
05:45 PM
ALLEGATION(S):
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report of mold in the facility
delayed response to repairs in the building due to insufficient staffing
improper rate increase
INVESTIGATION FINDINGS:
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On 04/10/2025, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced subsequent complaint investigation to deliver findings. LPA explained the purpose of visit to Sale Director Jonathan Monroe. Administrator, Jessica Sanchez was notified of visit via phone .

Allegation: Report of mold in the facility. During this investigation, LPA toured each building and conducted interviews. During the tour, LPA did not observe mold in the facility. There were no reports made to the Administrator regarding mold in the facility. Based on observations and interviews, this allegation is UNSUBSTANTIATED. 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.

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

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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-20250220095235
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: PACIFIC GROVE SENIOR LIVING
FACILITY NUMBER: 277209241
VISIT DATE: 04/10/2025
NARRATIVE
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Allegation: Delayed response to repairs in the building due to insufficient staffing. During this investigation, LPA toured the facility and interviewed residents and staff. Based on records provided, there is no evidence of insufficient staffing. Consistent statements during interviews revealed that residents were informed that the “building is very old, and it takes time to address any kind of repair”. Based on records review and interviews, this allegation is UNSUBSTANTIATED. 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.

Allegation: Improper rate increase. During this investigation, LPA reviewed records and conducted interviews. LPA discovered through records review and interviews, that all residents receive a rate increase on their anniversary date of being admitted to the facility. Based on interviews and records review, this allegation is UNSUBSTANTIATED. 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.

No deficiencies issued during this inspection.

Exit interview conducted. A copy of this report was discussed and provided to the facility representative. Report signed on-site.

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

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20250220095235
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: PACIFIC GROVE SENIOR LIVING
FACILITY NUMBER: 277209241
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2025
Section Cited
HSC
87468.1(a)(2)
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87468.1 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: (2) To be accorded safe, healthful and comfortable accommodations; this requirement was not met as evidenced by:
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The facility stated they will appeal this complaint finding. No POC provided
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Based on interviews conducted, the licensee did not comply with section 87468.1(a)(2) when constructions crew began working prior to 7:00AM and played loud music, which is an immediate health and safety risk to residents in care.
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The facility plan to follow city ordinance regarding work schedule. POC to be provided to Licensing Office by email or fax by POC due date.
Type B
04/15/2025
Section Cited
CCR
87303
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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 met as evidenced by:
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The facility will ensure each concern regarding plumbing or other issues addressed immediatly. the facility employs maintenance staff on shift that will and have been responding to residents needs as requested. POC statement will be provided by fax to Licensing office by POC due date.
Type B
04/15/2025
Section Cited
HSC
1569.695
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§1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift… this requirement was not met as evidenced by:
Based on record review and interviews, the Licensee did not comply with section 1569.695(c) when that the facility’s last documented fire drill was conducted on 02/24/2025 and prior to this, the last year fire drill was conducted on 04/30/2024, which is a potential health and safety risk to residents in care.
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The facility will make sure to conduct quarterly fire drills, record each fire drill with staff on each schedule. Provide an update to licensing office by fax or email on next fire drill by POC due date.
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: 04/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5