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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209004
Report Date: 01/15/2026
Date Signed: 02/09/2026 08:04:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 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
09/11/2025 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20250911082640
FACILITY NAME:QUAIL PARK AT SHANNON RANCHFACILITY NUMBER:
547209004
ADMINISTRATOR:MOYER, JEFFFACILITY TYPE:
740
ADDRESS:3330 & 3440 W FLAGSTAFF AVETELEPHONE:
(559) 527-8245
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:150CENSUS: 93DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Administrator, Kim Santos TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not ensure resident's medication is administered as prescribed
Staff do not follow reporting requirements
Staff did not ensure resident's showering needs are met
INVESTIGATION FINDINGS:
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On 01/26/2025, Licensing Program Analyst (LPA) Sarah Hurt arrived to the facility unannounced to deliver findings on the above allegation. LPA met with Facility Administrator, Kim Santos, and stated the purpose of the visit.

Regarding the allegation Staff did not ensure resident's medication is administered as prescribed. Resident 1's MAR documents multiple missed medications including on 09/18/25 p.m., and 09/19/2025 both a.m. and p.m. Based on records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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 4
Control Number 24-AS-20250911082640
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: QUAIL PARK AT SHANNON RANCH
FACILITY NUMBER: 547209004
VISIT DATE: 01/15/2026
NARRATIVE
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Regarding the allegation Staff do not follow reporting requirements. Facility staff and Reporting party both stated Staff 1 was not reporting all incidents involving residents medications, administering of medications, and communication with home health to resident 1's responsible party. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.


Regarding the allegation Staff did not ensure resident's showering needs are met. The facilities care notes document Resident 1 was not consistently showered. The care notes document three showers, and one shower refusal during the months of August, September, and October 2025. The care notes document showers on 08/05/2025, 09/01/2025, and 10/06/2025, and the one refusal on 09/29/2025. The facilities shower log does not have resident 1 listed Based on records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficiencies are cited Per Title 22 Regulations. Exit interview conducted with facility Administrator Kim Santos. A copy of this report was provided at the time of visit
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20250911082640
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: QUAIL PARK AT SHANNON RANCH
FACILITY NUMBER: 547209004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2026
Section Cited
CCR
87465(a)(4)
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87465 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. The following requirement has not been met as evidenced by:
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Administrator will conduct audits with facility Health and Wellness director to ensure all medications are being administered to facility residents, and submit proof to LPA by POC date of 01/27/2026..
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Resident 1's MAR documents multiple missed medications including on 09/18/25 p.m., and 09/19/2025 both a.m. and p.m., which poses is an immediate health, safety, or personal rights risk to residents in care.
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Type B
02/09/2026
Section Cited
CCR
87211(a)(1)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. The following requirement has not been met as evidenced by:
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Administrator will conduct communication with facility Health and Welness director on the subject of reporting and communication with resident responsible parties, and submit to LPA by 02/09/2026.
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Resident 1's Responsible party was not notified of communication with home health agency effecting Resident 1's care, which poses a potential, health, safety, or personal rights risk to residents 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: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20250911082640
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: QUAIL PARK AT SHANNON RANCH
FACILITY NUMBER: 547209004
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2026
Section Cited
CCR
87464(d)
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87464 Basic Services
(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.. The following requirement has not been met as evidenced by:
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Administrator will conduct training with facility staff on documenting shower logs including refusals, and submit to LPA by POC date of 02/09/2026.
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Resident 1 was not being assisted as needed with showers, which poses a potential, health, safety, or personal rights risk to residents 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: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4