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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 11:18:50 AM

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
09/08/2025 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250908102257
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:
02:41 PM
MET WITH:Lisa OngTIME COMPLETED:
03:57 PM
ALLEGATION(S):
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“This report is being amended to update the reporting manager.”

Facility is in disrepair
Facility does not provide resident with proper window dressings
Staff mismanaged residents' medications
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: Facility is in disrepair, Facility does not provide resident with proper window dressings, and Staff mismanaged residents' medications are SUBSTANTIATED.
During a facility tour conducted on 9/24/2025, it was observed that the facility is in disrepair and has not been maintained by the Licensee. Licensee was informed that the following areas were in disrepair: resident bathrooms, resident rooms, facility shower bathroom, facility exit doors, the perimeter fence, the facility kitchen and facility food pantry. Deficiencies were cited on case management visit conducted on 10/23/2025.
During the tour, it was found that multiple windows were missing blinds or window dressings, and the window dressing that were covering the window, were dirty and in need of replacement. Deficiencies were cited on case management visit conducted on 10/23/2025.
During the tour, a small box of medications were observed to be hidden in R1’s closet. Per R1, the medications were placed in the facility dumpster and R1 retrieved them.
A deficiency is 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 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 1
Control Number 24-AS-20250908102257
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
87465(h)(2)
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“This report is being amended to update the reporting manager.”

87465 Incidental Medical and Dental Care
(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication… This requirement was not met as evidenced by:
Based on observations and interviews, the Licensee did not comply with this section when medications were observed to be accessible to persons other than the employees, which is an immediate health and safety risk to persons in care.
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Licensee has submitted a closure plan and has notified the Department 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 3
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
09/08/2025 and conducted by Evaluator Les Xiong
COMPLAINT CONTROL NUMBER: 24-AS-20250908102257

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:
02:41 PM
MET WITH:Lisa OngTIME COMPLETED:
03:57 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
“This report is being amended to update the reporting manager.”

Staff throws objects at resident
Staff denied resident meals
INVESTIGATION FINDINGS:
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3
4
5
6
7
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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 throws objects at resident and Staff denied resident meals are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Licensee. Report signed on-site.
Unsubstantiated
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: 3 of 3