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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209241
Report Date: 09/16/2025
Date Signed: 09/17/2025 07:14:48 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
08/26/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250826101508
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: 79DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
03:47 PM
MET WITH:Jonathan Monroe, sales directorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are exposed to harmful chemicals.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/16/2025, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to deliver findings on a complaint investigation. LPA explained the purpose of the visit to administrator Jessica Sanchez 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: Residents are exposed to harmful chemicals. Based on interviews and record reviews, once facility administrator was notified on August 25th, of smell in residents’ room, painting was terminated. During the facility tour, on August 26th, LPA did not observe the harmful smell or smell of the paint. 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 above allegation is UNSUBSTANTIATED.
No deficiencies issued.
Exit interview conducted. Report signed on-site. A copy of this report provided to the facility representative.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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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