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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547200844
Report Date: 10/02/2025
Date Signed: 10/02/2025 04:23:48 PM

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
06/19/2025 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250619110641
FACILITY NAME:MARBELLA VISALIAFACILITY NUMBER:
547200844
ADMINISTRATOR:RANCOUR, MANDYFACILITY TYPE:
740
ADDRESS:3120 W. CALDWELLTELEPHONE:
(559) 735-0828
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:72CENSUS: 44DATE:
10/02/2025
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Mandy RancourTIME COMPLETED:
04:35 PM
ALLEGATION(S):
1
2
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9
Facility staff did not ensure to follow resident food restrictions.
Facility staff are not providing adequate food service to residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
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13
On 10/02/2025, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced subsequent complaint visit. LPAs introduced themselves, stated purpose of visit and allowed entrance. LPAs met with Executive Director, Mandy Rancour.

During the subsequent visit, LPAs conducted interview with Executive Director, toured kitchen, and obtained additional information. Based on LPA's observation and record review, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED.

No deficiencies issued during this complaint visit .

Exit interview conducted. A copy of this report will be provided by email to Executive Director.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
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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