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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700224
Report Date: 04/02/2026
Date Signed: 04/06/2026 12:15:27 PM

Substantiated


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
01/16/2026 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260116162721
FACILITY NAME:JOANN'S HOME CAREFACILITY NUMBER:
312700224
ADMINISTRATOR:ANTONE, DAVID RUBENFACILITY TYPE:
740
ADDRESS:6596 ROSE BRIDGE DRIVETELEPHONE:
(916) 771-4901
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 6DATE:
04/02/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:David AntoneTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident wandering away from the facility
INVESTIGATION FINDINGS:
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On 4/2/26, Licensing Program Analyst (LPA) Kevin Mknelly spoke to xxx xxx, title... to deliver complaint findings for the above allegation.

LPA reviewed resident records, facility records and conducted extensive interviews.
LPA finds that the allegations cited above are substantiated.

On 1/12/26, facility incident report and police report stated that R1 left the home unattended at approximately 6:16 PM, was found by neighbors approximately 200 yards from their home, neighbors reported the missing person to 9-1-1 and responding officers returned R1 to their home. R1 was
unharmed.
The police report stated that the sole caregiver (S1) working at the time told them that R1 was engaged with a puzzle in the dining area when caregiver began their shift and left R1 temporarily unattended while caregiver showered and changed clothes. When caregiver returned, R1 could not be found in the home and a search was begun.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
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 4
Control Number 59-AS-20260116162721
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: JOANN'S HOME CARE
FACILITY NUMBER: 312700224
VISIT DATE: 04/02/2026
NARRATIVE
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In a 1/7/26 physician’s evaluation (LIC 602), R1 is described as having dementia, lack of hazard awareness and impulse control , has unsafe wandering and is an elopement risk. R1 is recommended to not leave the home unassisted.

Since this unexpected event, the licensee has enhanced their alarm system and updated staffing procedures, and reviewed applicable staff training to mitigate any further unsafe leaving by residents.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with . Copy of this report and appeal rights provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20260116162721
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: JOANN'S HOME CARE
FACILITY NUMBER: 312700224
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2026
Section Cited
CCR
87411(a)
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Personnel Requirements - General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met based on records and statements. This posed an immediate risk to R1.
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The licensee has already enhanced security measures, monitoring of R1 and done additional staff traing of staff regarding mitigating elopement risks and elopement response procedures.
This citation is cleared by today's visit.
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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: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
01/16/2026 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20260116162721

FACILITY NAME:JOANN'S HOME CAREFACILITY NUMBER:
312700224
ADMINISTRATOR:ANTONE, DAVID RUBENFACILITY TYPE:
740
ADDRESS:6596 ROSE BRIDGE DRIVETELEPHONE:
(916) 771-4901
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 6DATE:
04/02/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Davis AntoneTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not ensure the facility auditory device was enabled to monitor exits or exterior doors and alert staff to prevent residents from eloping
INVESTIGATION FINDINGS:
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 On 4/2/26, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with xxx xxx.
LPA conducted interviews.
LPA is unable to find and or meet the preponderance, per policy.
In interviews with staff and R1, it was found that due to R1’s cognitive disability, R1 was not able to provide reliable accounts of the incident. It was unclear whether R1 disabled door alarms that failed to alert S1 to R1’s departure from the home.
The licensee has upgraded alarms to reduce the risk of residents disarming the alarm and staff retraining has occurred that alarms are to be on and functional at all times.
As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview with administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4