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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547208809
Report Date: 04/11/2025
Date Signed: 04/11/2025 03:01:49 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
03/20/2025 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20250320080931
FACILITY NAME:PARK VISALIA ASSISTED LIVINGFACILITY NUMBER:
547208809
ADMINISTRATOR:AMANDA KELSEYFACILITY TYPE:
740
ADDRESS:3939 WEST WALNUT AVENUETELEPHONE:
(559) 625-3388
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:110CENSUS: 76DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Executive Director/ Administrator Amanda KelseyTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do no prevent residents from developing pressure injuries
Staff do not assist residents with obtaining medical care
Staff are not distributing residents' medications as prescribed
Staff do not prevent resident from smoking inside of the facility
Staff do not observe resident for change in condition
Staff do not provide residents with personal care items
Staff do not maintain personal protective equipment at facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) K. Kaur and M. Yang arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Executive Director/ Administrator Amanda Kelsey and explained the purpose of the visit and reviewed the elements of the allegations. LPAs delivered the following complaint investigation findings.

During the course of the investigation, the department conducted interviews, reviewed records, and toured the facility. The Department investigated the allegations listed above. Based on interviews conducted and observations residents R1, R4 were observed with heal cushion/support pillows to prevent pressure injuries. Residents R1, R3, R4 were observed with no open wounds. Based on records reviewed and interviews conducted a wound specialist conducts visits once a week with R2 and resident is under home health care. R2 smokes in the designated smoking area in the back parking lot. Medication is administered as prescribed. Adequate PPE supplies and Personal care items were observed in the facility. Based on records reviewed there was insignificant evidence to prove or disprove that staff did not observe residents for change in condition.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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-20250320080931
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: PARK VISALIA ASSISTED LIVING
FACILITY NUMBER: 547208809
VISIT DATE: 04/11/2025
NARRATIVE
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32
Based interviews conducted, observations, and record reviewed the above allegations were investigated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2