547203298-6-2-2026-24-AS-AWAN-DFDN29-20250403100420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547203298
Report Date: 03/03/2025
Date Signed: 06/02/2026 03:56:59 PM

Unfounded

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
10/15/2024 and conducted by Evaluator Les Xiong

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20241015112559

FACILITY NAME:	AUTUMN OAKS		FACILITY NUMBER:	547203298
ADMINISTRATOR:	ONG, ANTONIO G.		FACILITY TYPE:	740
ADDRESS:	848 N. JAYE STREET		TELEPHONE:	(559) 784-4144
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	44	CENSUS:	DATE:	03/03/2025
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Matilde Garcia		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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“This report is being amended to update the reporting manager.”

Facility is not providing residents with adequate food.
Facility has rodants in the kitchen and resident rooms.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility.
During the course of this investigation LPA spoke to residents and staff relevant to the complaint investigation. It was determined that the above allegation: Facility is not providing residents with adequate food, and Facility has rodants in the kitchen and resident rooms are UNFOUNDED. LPA observed from the evidence from the investigation that there were adequate food and there were no rodents in the kitchen and residents' room since. This agency has investigated the complaint alleging (Facility is not providing residents with adequate food, and Facility has rodants in the kitchen and resident rooms). We have found that the complaint was unfounded, therefore we have dismissed the complaint.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

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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