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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547200844
Report Date: 03/06/2026
Date Signed: 03/06/2026 02:31:01 PM

Substantiated


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
03/03/2026 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20260303131432
FACILITY NAME:MARBELLA VISALIAFACILITY NUMBER:
547200844
ADMINISTRATOR:VIVIAN VILLEGASFACILITY TYPE:
740
ADDRESS:3120 W. CALDWELLTELEPHONE:
(559) 735-0828
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:72CENSUS: DATE:
03/06/2026
UNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Resident Care Director Brittney PolmanTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not administer residents medication in a timely manner.
Staff do not keep an accurate medication log.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Kaur arrived at the facility for initial 10-day complaint inspection. Administrator was unavailable to meet. LPA met with Resident Care Director Brittney Polman and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on observations, interviews conducted and records reviewed, the facility med-cart keys were locked in the cart on 03/2/2026 in error. Staff did not administer residents’ medication in a timely manner. The facility was unable to open the med-cart until 3/3/2026 6 AM. Residents R1 – R6 did not get 3/2/26 night medications. During Medication review facility discovered Staff were not keeping a log of medications in the Centrally Stored Medication and Destruction Record.

The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Repeat Civil penalties assessed. Exit interview was conducted with Resident Care Director and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026
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 2
Control Number 24-AS-20260303131432
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: MARBELLA VISALIA
FACILITY NUMBER: 547200844
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/07/2026
Section Cited
CCR
87465(a)(4)
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87465(a)(4) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
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Facility has made the following corrections: Facility has removed med-tech to caregiver duties. Facility has received 3 key copies from Pharmacy. Facility has implemented rules to ensure keys are not misplaced in the future.

Licensee agrees to submit a statement of intent regarding training by due date. Licensee will conduct medication training with all Med-Tech staff and submit documentation of training when completed.
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Based on observation, interview, and record, facility did not comply with the regulations listed above, which poses an immediate health and safety risk to residents in care. R1 – R6 did not receive their medications the evening of 3/2/26.
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Type A
03/09/2026
Section Cited
CCR
87465(h)(6)
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87465(h)(6) - Incidental Medical and Dental Care: (h)The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes…

This requirement is not met as evidenced by:
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Licensee agrees to submit a statement of intent regarding training by due date. Licensee will conduct medication training with all Med-Tech staff and submit documentation of training when completed.
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Based on interviews conducted and records reviewed, facility had an issues receiving Centrally Stored Medication records from Pharmacy. Facility staff were supposed to log medications on Centrally Stored Medication and Destruction log and failed to do so.
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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: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2