<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209241
Report Date: 06/05/2025
Date Signed: 07/31/2025 02:40:51 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
06/04/2025 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20250604143222
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:
06/05/2025
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:administrator Jessica SanchezTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff is interfering with resident receiving notification and watching upcoming event
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is an amended repot
On 06/05/2025, Licensing Program Analyst (LPA) V Gorban conducted complaint commencement visit to the facility on above allegation. LPA met with Administrator (AD) Jessica Sanchez and stated the purpose of the visit.
During the course of the investigation, LPA conducted a facility tour, interviewed administrastor and residents.
The Department has investigated the allegation: Facility staff in interfering with resident receiving notification and watching upcoming event. Through interviews conducted with residents, it was discovered that facility staff interfered with residents receiving memo in mailboxes, although facility staff allowed resident to watch upcoming event. Based on observations and interviews, the preponderance of evidence standard has been met therefore the allegation is SUBSTANTIATED. A deficiency is being cited with civil penalty assessed on the attached LIC9099-D.
Exit interview conducted. Report was not signed. A copy of this report and appeal rights were discussed and provided to the facility records.

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

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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 2
Control Number 24-AS-20250604143222
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: 06/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/06/2025
Section Cited
CCR
87468.2(a)(3)
1
2
3
4
5
6
7
87468.2 (a)(3) Personal rights
(3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated the complaint allegation will be submitted for appeal.
8
9
10
11
12
13
14
Based on interviews and record review, the Licensee did not comply with section 887468.2 (a)(3) when facility failed to provide residents free from discrimination their personal rights by refusing residents to their personal mail boxes for distributing memos, which is a potential health and safety risk to person’s in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2