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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209241
Report Date: 07/10/2025
Date Signed: 07/25/2025 08:14:51 AM

Unfounded


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
04/18/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250418160456
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: 76DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Administrator Jessica SanchezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility does not employ a qualified food service consultant

INVESTIGATION FINDINGS:
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On 07/10/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to commence a complaint investigation. LPA explained the purpose of the visit to the administrator and was allowed entry.
During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records.

The Department has investigated the allegation Facility does not employ a qualified food service consultant. Interviews were conducted with facility residents, staff and administrator. Based on the information obtained during the interview and records provided, the facility employs licensed food dietitian. The allegation Facility does not employ qualified food service consultant in Unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted report signed and copy of this report provided to administrator for facility records.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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 3
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
04/18/2025 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20250418160456

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: 76DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Administrator Jessica SanchezTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Disaster drills are not being conducted as required
INVESTIGATION FINDINGS:
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On 07/10/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to commence a complaint investigation. LPA explained the purpose of the visit to the administrator, and was allowed entry.

During the course of the investigation, LPA conducted a facility tour, conducted interviews, and reviewed records.
The Department has investigated the allegation Disaster drills are not being conducted as required, quarterly on each shift. Based on information obtained from facility administrator, the allegation disaster drills are not being conducted as required 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 9099D.
Exit interview conducted, report signed and copy of this report with appeal rights provide to administrator for facility records.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20250418160456
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: 07/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2025
Section Cited
HSC
1569.695(c)
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Emergency Plans. (c) A facility shall conduct a drill at least quarterly for each shift...... Documentation of the drills shall include the date, the type of emergency covered by the drill. This requirement was not observed as evidenced by:
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Administrator will conduct emergency disaster drill according to regulation and once completed to be provide to Licensing agency or LPA to email. Anticipated disaster drill July 31st.
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Based on interviews and records review the facility have not conducted recent emergency disaster drill and or maintained the records of last emergency disaster drill conducted recently, 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: 07/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3