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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 02:35:59 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
06/18/2025 and conducted by Evaluator Les Xiong
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250618114755
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: DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Lisa OngTIME COMPLETED:
12:59 PM
ALLEGATION(S):
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“This report is being amended to update the reporting manager.”

Staff do not ensure that bathrooms have towels
Staff do not ensure resident has clean bedding
Staff do not provide adequate food service
INVESTIGATION FINDINGS:
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This is an amended report. Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation to the facility. During the course of this investigation, LPA reviewed facility files relevant to the complaint and conducted a facility tour.
It was determined that the above allegations: Staff do not ensure that bathrooms have towels, Staff do not ensure resident has clean bedding, and Staff do not provide adequate food service are SUBSTANTIATED.
The evidence from the investigation indicated the facility did not have a sufficient supply of linen to provide to 24 residents. Licensee did not ensure clean linen were in use by residents at all times. Towels were observed to have holes and discoloration. Resident bedding was observed to dirty and damaged with holes exposing the comforter’s inner filling. Facility staff did not provide the residents with clean bedding when requested.
Evidence from the investigation revealed that the facility is not properly storing food and was not providing food that is in good quality to the residents in care.
Deficiencies are being issued in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D. Exit interview conducted and a plan of correction was developed with the Licensee. A copy of this report and appeal rights were discussed and provided to the Licensee, whose signature on this form confirms receipt of this document.
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-20250618114755
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 B
10/31/2025
Section Cited
CCR
87555(a)
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“This report is being amended to update the reporting manager.”

87555 General Food Service Requirements
(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents… This requirement was not met as evidenced by;
Based on observations, the Licensee did not comply with this section when the facility did not properly store or provide meals of good quality and quantity to meet the needs of the residents.
Licensee has submitted a closure plan to surrender the facility license. POC cleared
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POC cleared.
Type B
10/31/2025
Section Cited
CCR
87307(a)(3)(C)
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87307 Personal Accommodations and Services (a)(3)(C)
Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited… This requirement was not met as evidenced by;
Based on observation, the Licensee did not comply with this section when linens including bathroom linens and bedding were not sufficient in quality or quantity, which is a potential health and safety risk to persons in care.
Licensee has submitted a closure plan to surrender the facility license.

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POC cleared.
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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