095920187-2-23-2026-59-AS-LMUZ-DRLPRK-20260224103250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 095920187
Report Date: 02/23/2026
Date Signed: 02/23/2026 03:16:03 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2025 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20251125150454

FACILITY NAME:	PAVILION AT EL DORADO HILLS, THE		FACILITY NUMBER:	095920187
ADMINISTRATOR:	DELGADO, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	2288 FRANCISCO DR		TELEPHONE:	(916) 542-3452
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	64	CENSUS: 64	DATE:	02/23/2026
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator Kim Delgado		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Residents sustained injuries due to staff neglect
Staff did not prevent the spread of scabies
Staff are not following infection control requirements
Staff did not notify residents authorized representatives of incidents
Staff did not ensure they had PPE

INVESTIGATION FINDINGS:

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On February 23, 2026, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Kim Delgado.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026

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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Control Number 59-AS-20251125150454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PAVILION AT EL DORADO HILLS, THE	FACILITY NUMBER: 095920187
	VISIT DATE: 02/23/2026

NARRATIVE

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Residents sustained injuries due to staff neglect
The department conducted interviews, facility observation and record review to investigate the above allegation. During interviews with facility staff, it has been discovered that facility provided appropriate care to the residents based on resident’s documented needs and service plans. Six (6) staff interviews revealed that they were not aware of any injuries of any residents in care that were due to staff neglect; therefore, the above allegation is found to be UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Staff did not notify residents authorized representatives of incidents
The department conducted interviews and reviewed records concerning the allegation above. Through six (6) staff interviews it was determined that staff do contact responsible parties (RP) regarding all incidents such as falls, med errors, etc. Based on information gathered, the department finds the allegations to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Staff did not ensure they had PPE
Staff did not prevent the spread of scabies
Staff are not following infection control requirements
Based on observation, record review, and statement reviewed, the facility was following infection control requirements. As a precaution, during the first sign of a rash, facility puts out PPE outside the resident room, notifies staff of the potential of scabies, and an in-service to staff is reviewed on proper handwashing and universal precautions. Facility encouraged residents to stay in their room during the episode. It was observed facility had required PPE outside the resident room; therefore, the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. Report left with facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2026

LIC9099 (FAS) - (06/04)

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