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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547203298
Report Date: 10/30/2025
Date Signed: 06/02/2026 02:21:18 PM

Substantiated


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
08/29/2025 and conducted by Evaluator Les Xiong
COMPLAINT CONTROL NUMBER: 24-AS-20250829085606
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: 2DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Lisa OngTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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“This report is being amended to update the reporting manager.”

Staff does not ensure facility is kept free of pests
Staff speaks inappropriately to residents in care
Staff does not ensure residents personal property is safely secured
INVESTIGATION FINDINGS:
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On 10/30/2025, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with the Licensee.
During the course of the investigation, LPA reviewed records, conducted a facility tour and interviewed residents and staff.
It was determined that the above allegations: Staff does not ensure facility is kept free of pests, Staff speaks inappropriately to residents in care and Staff does not ensure residents personal property is safely secured are SUBSTANTIATED.
The evidence from the investigation indicated that the facility has a roach and bed bug infestation. Although the facility is receiving pest control services, the service selected is not sufficient as the Licensee has pest control “only spray a few rooms”. Based on interviews conducted, it was found that the Licensee told R1 “that she would give R1 $2000, if R1 leaves” while Licensee presented an eviction notice to R1. Interviews with Administrator revealed that facility staff recently “deep cleaned” and disposed of items belonging to previous residents that resided at the facility. Licensee stated that current resident clothing was not disposed of unless the residents placed a trash bag in the hallway. However, upon review of records, it was discovered that the Licensee did not maintain accurate records of resident’s personal belongings.
Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D.
Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to the Licensee. Report was signed on-site.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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-20250829085606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: AUTUMN OAKS
FACILITY NUMBER: 547203298
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2025
Section Cited
CCR
87464(f)
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“This report is being amended to update the reporting manager.”

87464 Basic Services
(f) Basic services shall at a minimum include: (2) Safe and healthful living accommodations and services… this requirement was not met as evidenced by:
Based on interviews and observations, the Licensee did not comply with this section when did not address the roach and bed bug infestation sufficiently resulting in 24 out of 24 residents to be living unsafe living conditions… which is an immediate health and safety risk to persons in care.
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Licensee has submitted a closure plan and has given notice that the Licensee will surrender the facility license.
Type A
10/31/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities


(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons… This requirement was not met as evidenced by:
Based on interviews, the Licensee did not comply with this section when the Licensee stated that she would give $2000 to R1 if R1 would leave while serving an eviction notice. Which is a potential health and safety risk to persons in care.
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Licensee has submitted a closure plan and has given notice that the Licensee will surrender the facility license.
Type A
10/31/2025
Section Cited
CCR
87218(a)(1)
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87218 Theft and Loss
(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153.(1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative… This requirement was not met as evidenced by:
Based on record review and interviews, the Licensee did not comply with this section when the personal property for each resident was not inventoried upon admission… which is a potential health and safety risk to persons in care.
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Licensee has submitted a closure plan and has given notice that the Licensee will surrender the facility license.
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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: Alexandria Walton
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2