Inspection Report Summary
Most inspections at this facility were clean, including the most recent report dated August 15, 2025, which had no deficiencies. Several complaint investigations were unsubstantiated, with allegations such as improper medication administration, inadequate resident care, and restricted resident movement found to be without basis. However, there were some deficiencies in prior years related primarily to medication administration errors and resident supervision, including incidents where residents received the wrong medications and cases of inadequate supervision leading to residents leaving the facility unsupervised. These issues resulted in civil penalties, including a $500 fine in 2021 and a $250 fine in 2022, but no enforcement actions or license suspensions are listed in the available reports. The facility appears to have improved over time, with recent inspections showing no deficiencies and appropriate responses to earlier incidents.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Census: 56
Capacity: 68
Deficiencies: 0
Aug 15, 2025
Visit Reason
The visit was an unannounced case management inspection to provide the facility with an updated license.
Findings
No deficiencies were issued during this visit. The Licensing Program Analyst provided the updated license and recovered the old license.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Anne Venegas | Executive Director | Met with Licensing Program Analyst during the visit and received the report. |
| Martin Vega | Licensing Program Analyst | Conducted the unannounced visit and provided updated license. |
| Brenda Chan | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 68
Deficiencies: 0
Jun 17, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that the facility licensee does not ensure that staff has a criminal clearance.
Findings
The investigation found that the facility does ensure staff have criminal clearances, and the allegation was determined to be unfounded. No deficiencies were observed or cited during the visit.
Complaint Details
The complaint alleged that the licensee does not ensure staff have criminal clearances. The complaint was investigated and found to be unfounded, meaning the allegation was false or without reasonable basis, and the complaint was dismissed.
Report Facts
Capacity: 68
Census: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Venegas | Executive Director | Met with Licensing Program Analyst during the complaint investigation |
| Martin Vega | Licensing Program Analyst | Conducted the complaint investigation |
| Brenda Chan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 60
Capacity: 68
Deficiencies: 0
Apr 21, 2025
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate compliance with licensing requirements at Cedarbrook Memory Care Community.
Findings
The facility was found to be clean, in good repair, and free of hazards. Resident rooms and common areas were adequately furnished and maintained. Medications and chemicals were properly stored. Staff and resident files were reviewed and found to be up to date. No deficiencies were issued during this inspection.
Report Facts
Hot water temperature: 114.9
Refrigerator temperature: 32
Freezer temperature: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Anne Venegas | Executive Director | Met with Licensing Program Analyst during inspection and received report |
| Martin Vega | Licensing Program Analyst | Conducted the inspection |
| Brenda Chan | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 68
Deficiencies: 0
Apr 21, 2025
Visit Reason
The visit was conducted as a case management incident investigation due to a reported medication error involving residents and a caregiver at the facility.
Findings
The facility took immediate corrective actions including staff training and monitoring of the affected resident, with no adverse reactions reported. No deficiencies were cited as the facility complied with reporting requirements and took necessary steps to ensure resident safety.
Complaint Details
The complaint involved medication errors. The complaint was not substantiated as no deficiencies were cited and the facility demonstrated appropriate response and corrective measures.
Report Facts
Capacity: 68
Census: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Anne Venegas | Executive Director | Discussed concerns regarding medication errors and provided documentation of staff training |
| Martin Vega | Licensing Program Analyst | Acknowledged receipt of the report and involved in the case management discussion |
| Brenda Chan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 68
Deficiencies: 0
Apr 21, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff were not permitting a resident to leave the facility.
Findings
The investigation found the allegation to be unfounded. Residents, including Resident 1, were permitted to leave the facility under supervision, with documented proof of multiple outings and proper check-in/check-out procedures demonstrated by staff.
Complaint Details
The complaint alleging that staff were not permitting residents to leave the facility was investigated and found to be unfounded, meaning the allegations were false or without reasonable basis.
Report Facts
Facility capacity: 68
Census: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martin Vega | Licensing Program Analyst | Conducted the complaint investigation visit |
| Sarah Dennis | Administrator | Facility administrator mentioned in the report |
| Emily Venegas | Executive Director | Met with the investigator during the visit |
| Brenda Chan | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Follow-Up
Census: 61
Capacity: 68
Deficiencies: 0
Jan 9, 2025
Visit Reason
The visit was a case management follow-up on an incident report involving medication administration to a client.
Findings
The report found that immediate and appropriate action was taken following the incident, including notification of the physician and responsible party, staff discipline and retraining, and no adverse reactions to the resident. No deficiencies were cited.
Report Facts
Capacity: 68
Census: 61
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Emily Venegas | Executive Director | Spoke with Licensing Program Analyst about the incident |
| Kayleen | Regional Nurse | Reported staff discipline and retraining on medication administration |
Inspection Report
Census: 60
Capacity: 68
Deficiencies: 0
Nov 26, 2024
Visit Reason
The visit was an unannounced Case Management inspection conducted by the Licensing Program Analyst to evaluate compliance and address a Decision and Order excluding a staff member from the facility.
Findings
No deficiencies were observed or cited during the visit. The Licensing Program Analyst served a Decision and Order excluding a specific staff member from the facility premises and requested updates to personnel records accordingly.
Report Facts
Capacity: 68
Census: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kayleen August | Executive Director | Met with Licensing Program Analyst during the inspection and was informed about the exclusion order |
| Martin Vega | Licensing Program Analyst | Conducted the unannounced Case Management visit |
Inspection Report
Complaint Investigation
Capacity: 68
Deficiencies: 0
Oct 4, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that staff were not correctly administering medications.
Findings
Based on observation and records review, no issues with medication administration were found. The allegations were determined to be unsubstantiated and no deficiencies were issued.
Complaint Details
Allegation that staff is not correctly administering medications was investigated and found unsubstantiated due to lack of preponderance of evidence.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Executive Director | Met with Licensing Program Analyst during investigation and named in report. |
| Samantha Keith | Director of Resident Services | Reviewed medications with Licensing Program Analyst during investigation. |
| Martin Vega | Licensing Program Analyst | Conducted the complaint investigation visit. |
Inspection Report
Complaint Investigation
Capacity: 68
Deficiencies: 0
Oct 4, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to a complaint alleging that staff do not ensure resident’s catheter is properly maintained.
Findings
The investigation found that the resident's catheter was properly maintained with no evidence supporting the allegation. The allegations were determined to be unsubstantiated, and no deficiencies were issued.
Complaint Details
Complaint alleging staff do not ensure resident’s catheter is properly maintained. The complaint was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Facility capacity: 68
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Executive Director | Met with Licensing Program Analyst during investigation |
| Martin Vega | Licensing Program Analyst | Conducted the complaint investigation |
| Samantha Keith | Director of Resident Services | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 63
Capacity: 68
Deficiencies: 0
Sep 26, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2024-07-18 regarding multiple allegations about resident care at Cedarbrook Memory Care Community.
Findings
The investigation found no preponderance of evidence to substantiate the allegations, which included locked restrooms, inadequate food portions, lack of drinking water, unmet grooming needs, and lack of activities. Observations, interviews, and record reviews indicated the facility met care standards.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included locked restrooms, inadequate food portions, lack of drinking water, unmet grooming needs, and lack of activities. The facility provided evidence and observations that disproved these claims.
Report Facts
Capacity: 68
Census: 63
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Samantha Keith | Director of Resident Services | Met with Licensing Program Analyst during visit and discussed allegations |
| Vadim Gorban | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Brenda Chan | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Census: 60
Capacity: 68
Deficiencies: 0
May 21, 2024
Visit Reason
The visit was conducted as a case management incident inspection related to an incident involving resident R1 on 2024-05-11, focusing on the resident's increased lethargy and decreased responsiveness.
Findings
During the visit, the Licensing Program Analyst toured the facility, conducted a safety check, interviewed staff and the administrator, and reviewed incident reports. No deficiencies were cited during this visit.
Report Facts
Incident date: May 11, 2024
Incident report submission date: May 17, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during the visit and provided information about the incident |
| Vadim Gorban | Licensing Program Analyst | Conducted the case management incident visit |
| Brenda Chan | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 58
Capacity: 68
Deficiencies: 0
Apr 3, 2024
Visit Reason
The inspection was an unannounced required annual inspection conducted to evaluate the facility's compliance with licensing regulations.
Findings
The facility was found to be clean, in good repair, and free of hazards. Resident rooms and common areas were adequately furnished and maintained. Food storage and medication storage met regulatory standards. Staff and resident files were reviewed and found to be compliant. No deficiencies were issued during this inspection.
Report Facts
Facility capacity: 68
Resident census: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during inspection and named in report |
| Vadim Gorban | Licensing Program Analyst | Conducted the inspection |
| Brenda Chan | Licensing Program Manager | Named in report |
Inspection Report
Complaint Investigation
Census: 59
Capacity: 68
Deficiencies: 1
Feb 26, 2024
Visit Reason
The visit was conducted to address an incident where resident R1 went AWOL on 02/17/2024. The facility was unaware of the resident's absence, and the resident has dementia and is unable to leave unassisted.
Findings
A deficiency was cited due to failure to provide adequate care and supervision when resident R1 left the facility unsupervised. The facility was not aware of the resident's absence until notified by Fresno Police Department, posing an immediate health and safety risk.
Complaint Details
The visit was complaint-related due to an incident where resident R1 went AWOL. The deficiency was substantiated as the facility failed to provide adequate supervision.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide care and supervision when memory care resident R1 left the facility unsupervised on 02/17/24 at approximately 8:38 PM. The facility was unaware until 10:15 PM when Fresno PD notified them, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 68
Census: 59
Plan of Correction Due Date: Feb 27, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Samantha Keith | Director of Resident Services | Met during the inspection and received the report |
| Vadim Gorban | Licensing Program Analyst | Conducted the inspection and signed the report |
| Brenda Chan | Licensing Program Manager / Supervisor | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 68
Deficiencies: 1
Jan 4, 2024
Visit Reason
The visit was conducted as a case management response to an incident report received by the regional office on 2023-09-14.
Findings
The facility failed to submit an incident report to Licensing within the required seven-day timeframe, which posed a potential safety risk to residents in care.
Complaint Details
The visit was complaint-related, triggered by an incident report. The facility was found to have failed in timely notification to Licensing as required by Title 22.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility failed to submit incident report in timely manner to Licensing, which poses potential safety risk to residents in care. | Type B |
Report Facts
Capacity: 68
Census: 58
Deficiency count: 1
Plan of Correction Due Date: Jan 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during the visit and discussed findings |
| Vadim Gorban | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Brenda Chan | Licensing Program Manager | Supervisor overseeing the licensing evaluation |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 68
Deficiencies: 0
Dec 28, 2023
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 2023-10-02 alleging that staff did not assist a resident with obtaining medical care.
Findings
The investigation included a review of facility records and interviews with staff and the administrator. It was found that medical care was provided to the resident in need. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleging staff did not assist a resident with obtaining medical care was investigated and found to be unsubstantiated.
Report Facts
Capacity: 68
Census: 60
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Samantha Keith | Director of Resident Services | Met with Licensing Program Analyst during the investigation |
| Vadim Gorban | Licensing Program Analyst | Conducted the complaint investigation visit |
| Sarah Dennis | Administrator | Named as facility administrator and interviewed during investigation |
Inspection Report
Complaint Investigation
Census: 57
Capacity: 68
Deficiencies: 0
Aug 23, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-05-12 regarding staff mismanagement of residents' medication and staff giving resident medication from another resident.
Findings
The investigation found both allegations unsubstantiated after reviewing facility records, interviewing staff and the administrator, and observing the facility. No deficiencies were issued during this inspection.
Complaint Details
The complaint involved two allegations: staff mismanaged residents' medication and staff gave resident medication from another resident. Both allegations were found unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 68
Census: 57
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during investigation and named in findings |
| Vadim Gorban | Licensing Program Analyst | Conducted the complaint investigation |
| Brenda Chan | Licensing Program Manager | Named in report header and signature section |
Inspection Report
Complaint Investigation
Census: 58
Capacity: 68
Deficiencies: 0
Apr 5, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that a resident was being overcharged for services.
Findings
The investigation found that the facility was charging a resident for gloves and incontinence supplies, which is allowed by regulations. Therefore, the allegation of overcharging was unsubstantiated and no deficiencies were issued.
Complaint Details
The complaint alleged that a resident was being overcharged for services. The allegation was found to be unsubstantiated based on interviews and record review.
Report Facts
Capacity: 68
Census: 58
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during investigation and named in findings |
| Alexandria Walton | Licensing Program Analyst | Conducted the complaint investigation |
| Melinda Hoffmann | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 60
Capacity: 68
Deficiencies: 0
Feb 16, 2023
Visit Reason
The visit was an unannounced annual inspection focused on infection control conducted by the Licensing Program Analyst.
Findings
The facility appeared clean with no fire clearance issues, maintained social distancing, had adequate supplies of medications, food, cleaning and PPE, and staff were observed following infection control protocols. No deficiencies were found during the inspection.
Report Facts
Fire extinguisher service date: Jun 10, 2022
Water temperature: 105
Medication supply duration: 30
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during inspection and named in report |
| Vadim Gorban | Licensing Program Analyst | Conducted the inspection visit |
| Brenda Chan | Licensing Program Manager | Named in report |
Inspection Report
Census: 59
Capacity: 68
Deficiencies: 0
Jan 31, 2023
Visit Reason
The visit was an unannounced case management visit to complete a health and safety check on residents following a Special Incident Report (SIR) received by Community Care Licensing.
Findings
The Licensing Program Analyst toured the facility, reviewed resident files and staff training credentials, and advised the facility to update Needs and Services plans for fall risk residents. No citations were issued during this visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Named as the facility administrator contacted during the visit. |
| Narissa Rodriguez | Manager on duty | Met by Licensing Program Analyst during the visit and participated in the exit interview. |
| Vadim Gorban | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Brenda Chan | Licensing Program Manager | Named in the report header. |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 68
Deficiencies: 0
Dec 19, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 09/16/2022 regarding resident care issues including pressure injuries, lack of assistance with ambulating, and unmet dietary needs.
Findings
Based on interviews and record reviews, the allegations were found to be unsubstantiated due to lack of preponderance of evidence. No deficiencies were issued during the investigation.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included resident developed pressure injuries while in care, staff did not assist resident with ambulating, and facility did not meet resident's dietary needs. The investigation found no sufficient evidence to prove violations.
Report Facts
Capacity: 68
Census: 56
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during investigation and received report |
| Alexandria Walton | Licensing Program Analyst | Conducted the complaint investigation |
| Melinda Hoffmann | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 55
Capacity: 68
Deficiencies: 1
Dec 19, 2022
Visit Reason
The visit was an unannounced case management inspection triggered by a Special Incident Report (SIR) alleging that resident R1 was administered medications belonging to resident R2, posing a potential health and safety risk.
Findings
The facility was found to have violated section 87465(a)(4) for failing to ensure proper medication administration, resulting in a repeat violation with a civil penalty to be applied. The Executive Director acknowledged the deficiency and outlined plans for staff monitoring and training.
Complaint Details
The visit was complaint-related based on a Special Incident Report (SIR) received by Community Care Licensing alleging medication administration errors. The violation was substantiated as a repeat violation with civil penalties to be applied.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility staff administered medications belonging to resident R1 to resident R2, posing an immediate health and safety risk. | Type A |
Report Facts
Capacity: 68
Census: 55
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Executive Administrator | Met with Licensing Program Analyst during inspection and named in findings |
| Vadim Gorban | Licensing Program Analyst | Conducted the inspection |
| Brenda Chan | Licensing Program Manager | Supervisor named in report |
Inspection Report
Follow-Up
Census: 59
Capacity: 68
Deficiencies: 1
Oct 13, 2022
Visit Reason
The visit was conducted as a follow-up on an incident report submitted to the Fresno CCL office regarding medication administration errors on 10/03/2022.
Findings
The facility was found to have administered medications belonging to resident R2 to resident R1, posing an immediate health and safety risk. A deficiency was cited and a civil penalty of $250 was assessed for a repeat violation.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility staff administered medications belonging to resident R2 to resident R1, violating medication administration requirements. | Type A |
Report Facts
Civil penalty amount: 250
Deficiency count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Samantha Keith | Director of Resident Services | Met with Licensing Program Analyst during visit and involved in plan of correction |
| Alexandria Walton | Licensing Program Analyst | Conducted the case management visit and authored the report |
| Melinda Hoffmann | Licensing Program Manager | Supervisor overseeing the licensing evaluation |
Inspection Report
Census: 58
Capacity: 68
Deficiencies: 0
Sep 22, 2022
Visit Reason
The visit was an unannounced case management visit to return the complete file for resident R1 that was removed from the facility on 09/19/2022.
Findings
No deficiencies were issued during this visit. The Licensing Program Analyst met with the Business Office Manager as the Administrator was unavailable.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Named as the facility Administrator who was not available during the inspection. |
| Narissa Rodriguez | Business Office Manager | Met with Licensing Program Analyst during the visit and received the report. |
| Alexandria Walton | Licensing Program Analyst | Conducted the case management visit. |
| Melinda Hoffmann | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 56
Capacity: 68
Deficiencies: 0
Apr 20, 2022
Visit Reason
The visit was an unannounced complaint investigation conducted in response to a complaint received on 2022-03-11 alleging that residents were locked out of their rooms.
Findings
The investigation found that residents and families were informed that staff lock resident doors after exit to prevent wandering and theft, with staff available to unlock doors on request. Residents may have keys prior to admission. The allegation was unsubstantiated and no deficiencies were issued.
Complaint Details
The complaint alleged that residents were locked out of their rooms. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Capacity: 68
Census: 56
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gao Moua | Director of Resident Services | Met during investigation and involved in exit interview |
Inspection Report
Annual Inspection
Census: 55
Capacity: 68
Deficiencies: 1
Mar 8, 2022
Visit Reason
The visit was an unannounced annual inspection focused on infection control conducted by the Licensing Program Analyst to assess compliance with regulations.
Findings
The facility was generally clean with proper social distancing and mask use observed. However, a deficiency was cited for removing residents' medications from original containers and placing them in envelopes, which violates medication storage regulations.
Deficiencies (1)
| Description |
|---|
| Medications for residents were removed from the original packaging and placed in envelopes due to bottles not fitting in medication cart, violating the requirement that each resident's medication be stored in its originally received container. |
Report Facts
Plan of Correction Due Date: Apr 8, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Alexandria Walton | Licensing Program Analyst | Conducted the inspection and authored the report |
| Melinda Hoffmann | Licensing Program Manager | Supervisor overseeing the inspection |
| Sarah Dennis | Administrator | Facility administrator met during inspection |
Inspection Report
Follow-Up
Census: 55
Capacity: 68
Deficiencies: 1
Mar 8, 2022
Visit Reason
The visit was an unannounced Case Management inspection conducted to follow up on an Incident Report submitted on 2022-02-23 regarding a medication administration error.
Findings
The inspection found that a staff member (S1) administered medications prescribed for resident R1 to resident R2, posing an immediate health and safety risk. A deficiency was cited under California Code of Regulations, Title 22, Division 6.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to assist residents with self-administered medications as needed, evidenced by S1 administering medications prescribed to R1 to R2. | Type A |
Report Facts
Capacity: 68
Census: 55
Plan of Correction Due Date: Mar 9, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Administrator | Met with Licensing Program Analyst during inspection and involved in Plan of Correction development |
| Alexandria Walton | Licensing Program Analyst | Conducted the inspection and authored the report |
| Melinda Hoffmann | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 49
Capacity: 68
Deficiencies: 1
Nov 12, 2021
Visit Reason
The visit was conducted as a Case Management - Incident follow-up to investigate reported incidents involving a resident who was missing from the facility on 08/24/2021.
Findings
The inspection found that the facility failed to provide adequate care and supervision when a resident was not located in their bedroom and was found outside the facility. A deficiency was cited and a $500 civil penalty was assessed for absence of supervision.
Complaint Details
The visit was complaint-related, following up on incidents reported to the Fresno CCL office regarding a resident who was missing from the facility. The complaint was substantiated by the deficiency cited.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure all residents were provided care and supervision when on 8/24/2021, facility staff were unable to locate resident R1 in R1’s bedroom; resident was located outside the facility near Fresno State. | Type A |
Report Facts
Civil penalty amount: 500
Deficiency count: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sarah Dennis | Executive Director | Met during inspection and involved in plan of correction |
| Alexandria Walton | Licensing Program Analyst | Conducted the inspection |
| Melinda Hoffmann | Licensing Program Manager | Supervisor overseeing the inspection |
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