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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209399
Report Date: 12/18/2024
Date Signed: 12/23/2024 02:19:17 PM

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
08/15/2024 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240815140436
FACILITY NAME:DEL MONTE CAREFACILITY NUMBER:
277209399
ADMINISTRATOR:CABUCO, KAYFACILITY TYPE:
740
ADDRESS:1221/1229 DAVID AVETELEPHONE:
(919) 439-8488
CITY:PACIFIC GROVESTATE: CAZIP CODE:
93950
CAPACITY:65CENSUS: 32DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Victoria Montoya Med Tech ManagerTIME COMPLETED:
04:54 PM
ALLEGATION(S):
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Facility staff yelled at resident
Facility staff spoke inappropriately to resident
Facility staff did not ensure resident had drinking water
Facility staff did not ensure resident had a clean mattress
Facility staff did not maintain passageway free of obstruction
INVESTIGATION FINDINGS:
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On 12/18/2024, Licensing Program Analyst (LPA) V. Gorban visited the facility to deliver findings. During this visit LPA met with facility manager Victoria Montoya. Administrator (AD) Kay Cabuco was notified of Licensing visit.
During this visit LPA toured the facility inside and out, performing safety checks and observed residents in care.
Allegation: Facility staff yelled at resident. Based on observation one out of 5 residents interviewed appear to speak very loudly and requested LPA to speak clear and loud as well. Based observations and residents interviewed no reports of being yelled at. During files review no concerns from residents observed or reported.
Allegation: Facility staff spoke inappropriately to resident. During the visits on 8/18,9/10 and 12/06 LPA observed residents and care. During this visit LPA observed interactions of staff with residents. During facility visit staff and residents interviewed, both parties responded no to staff speaking inappropriately.
Report continues on attached LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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-20240815140436
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: DEL MONTE CARE
FACILITY NUMBER: 277209399
VISIT DATE: 12/18/2024
NARRATIVE
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Allegation: Facility staff did not ensure resident had drinking water. During the visit LPA toured and observed building 3 observed water cups and large containers filled with water available to residents for consumption. During interviews no water concern from residents interviewed.

Allegation: Facility staff did not ensure resident had a clean mattress. During the facility tour and observation, residents’ rooms, mattresses, and line appear to be washed and odor free. During interview with staff residents receive clean mattress and washed/ clean bedding twice a week and more if needed, clean bedding available upon request.

Allegation: Facility staff did not maintain passageway free of obstruction. During the facility visit on multiple occasions 8/19, 9/10, and 12/18 LPA toured the campus conducting safety checks. During those visits no passageway obstruction was observed.

Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated .

No deficiencies were observed during this visit.

Exit interview conducted, report signed and copy of this report provided for facility records.

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

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2