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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547203298
Report Date: 05/02/2025
Date Signed: 06/02/2026 03:48:57 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
11/25/2024 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241125232111
FACILITY NAME:AUTUMN OAKSFACILITY NUMBER:
547203298
ADMINISTRATOR:ONG, ANTONIO G.FACILITY TYPE:
740
ADDRESS:848 N. JAYE STREETTELEPHONE:
(559) 784-4144
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:44CENSUS: 24DATE:
05/02/2025
UNANNOUNCEDTIME BEGAN:
03:17 PM
MET WITH:Lisa OngTIME COMPLETED:
04:53 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
“This report is being amended to update the reporting manager.”

Staff did not ensure that the facility is kept clean.
Facility did not ensure that staff are properly trained to dispense medication.
Staff did not ensure that residents dietary needs are being met.
Staff made an inappropriate request of residents in care.
Staff are tampering with residents mail.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) conducted the complaint investigation visit to the facility.
During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegations: Staff did not ensure that the facility is kept clean, Facility did not ensure that staff are properly trained to dispense medication, Staff did not ensure that residents dietary needs are being met, Staff made an inappropriate request of residents in care, Staff are tampering with residents mail are UNFOUNDED. The evidence from the investigation indicated facility has house keeper cleaning the facility daily, staff that administered medication is properly trained, residents in the facility does not have doctor ordered special diet, staff did not inappropriately request of residents, and did not tamper residents' mail. This agency has investigated the complaint alleging (Staff did not ensure that the facility is kept clean, Facility did not ensure that staff are properly trained to dispense medication, Staff did not ensure that residents dietary needs are being met, Staff made an inappropriate request of residents in care, Staff are tampering with residents mail). 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: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
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
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
11/25/2024 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241125232111

FACILITY NAME:AUTUMN OAKSFACILITY NUMBER:
547203298
ADMINISTRATOR:ONG, ANTONIO G.FACILITY TYPE:
740
ADDRESS:848 N. JAYE STREETTELEPHONE:
(559) 784-4144
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:44CENSUS: 24DATE:
05/02/2025
UNANNOUNCEDTIME BEGAN:
03:17 PM
MET WITH:Lisa OngTIME COMPLETED:
04:53 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
“This report is being amended to update the reporting manager.”

Resident's are forced to give staff their debit cards.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility.

During this visit LPA delivered investigation findings regarding the above allegation.The Department has investigated the complaint alleging: Resident's are forced to give staff their debit cards. Based on the interviews conducted and/or records review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2