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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209489
Report Date: 04/16/2026
Date Signed: 04/17/2026 08:44:03 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
01/15/2026 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20260115090814
FACILITY NAME:COTTAGES OF CARMELFACILITY NUMBER:
277209489
ADMINISTRATOR:KELLIE SHEARERFACILITY TYPE:
740
ADDRESS:26245 CARMEL RANCHO BLVD.TELEPHONE:
(831) 620-1800
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:78CENSUS: 57DATE:
04/16/2026
UNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Administrator Kellie ShearerTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff are not documenting residents medication
Staff are not meeting resident's hygiene needs
Unqualified staff are administering medications
INVESTIGATION FINDINGS:
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On 04/16/2026 Licensing Program Analyst (LPA) Gorban unannounced visited the facility to commence complaint investigation. LPA introduced self and met by Administrator; LPA stated purpose of the visit and was allowed entry.
During the complaint investigation LPA toured the facility conducting health and safety checks, reviewed records, and interviews.
Allegations: Staff are not documenting residents’ medication, Staff are not meeting resident's hygiene needs, and Unqualified staff are administering medications. Based records reviews resident’s medications record confirmed medication records confirmed proper documentation. Based on staff interviews, resident will maintain own dental hygiene. Based on records review and staff interviews, training on medication administration provided to staff that have access to med cart. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated.
Report continues on attached LIC9099-A
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
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
FRESNO RO, 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
01/15/2026 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20260115090814

FACILITY NAME:COTTAGES OF CARMELFACILITY NUMBER:
277209489
ADMINISTRATOR:KELLIE SHEARERFACILITY TYPE:
740
ADDRESS:26245 CARMEL RANCHO BLVD.TELEPHONE:
(831) 620-1800
CITY:CARMELSTATE: CAZIP CODE:
93923
CAPACITY:78CENSUS: 57DATE:
04/16/2026
UNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Administrator Kellie ShearerTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Lack of care and supervision resulted in a resident sustaining injuries
INVESTIGATION FINDINGS:
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On 04/16/2026 Licensing Program Analyst (LPA) Gorban unannounced visited the facility to commence complaint investigation. LPA introduced self and met by Administrator; LPA stated purpose of the visit and was allowed entry.
During the complaint investigation LPA toured the facility conducting health and safety checks, reviewed records, and interviews.
Allegation: Lack of care and supervision resulted in a resident sustaining injuries. Based on interviews and record reviews, R1 diagnosed with dementia was observed early morning in bed with facial injuries unknown to staff therefore, the preponderance of evidence standard has been met, and the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 being cited on the attached LIC 9099D

Exit interview conducted report signed and with appeal right provide to Administrator fir facility records.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
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-20260115090814
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: COTTAGES OF CARMEL
FACILITY NUMBER: 277209489
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General.
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not observed as evidenced by:
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Administrator will review and provide a written plan of correction to LPA by email by POC due date.
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The facility dementia resident was observed in the morning with facial injuries unknown to staff. Based on interviews, R1 did not have facial injuries day prior, 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: Alexandria Walton
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3