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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700888
Report Date: 08/26/2025
Date Signed: 08/26/2025 12:47:20 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
06/26/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250626141112
FACILITY NAME:RNCARE HOUSE @ EAST ROSEVILLEFACILITY NUMBER:
312700888
ADMINISTRATOR:ESTANTE, EDWARDFACILITY TYPE:
740
ADDRESS:484 CALDARELLA CIRCLETELEPHONE:
(916) 200-8067
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 4DATE:
08/26/2025
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Hazel EstanteTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee unlawfully evicted resident.
Licensee did not issue a timely refund to resident.
INVESTIGATION FINDINGS:
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On 8/26/25, Licensing Program Analyst (LPA) Kevin Mknelly spoke to designee, Hazel Estante, to deliver complaint findings for the above allegation.

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

Records showed that R1 was admitted on 3/27/25. Physician report for R1, dated 3/26/25, stated R1 has mild cognitive impairment and failed to record a primary diagnosis for requiring assisted living.
Pre- placement appraisal, dated 3/27/25, however, notes impaired decision making due to dementia and
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
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 3
Control Number 59-AS-20250626141112
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: RNCARE HOUSE @ EAST ROSEVILLE
FACILITY NUMBER: 312700888
VISIT DATE: 08/26/2025
NARRATIVE
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post CVA, episodes of confusion/ forgetfulness. Identified care needs include- personal care, incontinence, medication, observation/ supervision and elopement risk.

Appraisal Needs and Services Plan, dated 3/27/25, noted R1 previously resided in memory care at another facility.
Review of R1’s records failed to find information as defined in updated regulations, effective 1/1/25, for intervention strategies/ techniques for behavioral expressions- in this case confusion, agitation and elopements.

Following the 4/7/25 incident, R1 was found to have a UTI, they were medically stabilized.
R1’s representative was notified by facility Administrator on 4/8/25 that due to R1’s aggressive episode and injury of staff, R1 may not return to the facility. R1 was relocated to another licensed care home. As R1 was not reassessed and offered the possibility of returning to this facility, R1 was involuntarily discharged without an eviction notice.

R1’s representative requested reimbursement for fees paid for the remainder of April 2025 following the involuntary discharge. The representative was initially told that calculations for the reimbursement will be based on staff injury care and property damage costs. Admission agreement regulation does not allow for such deductions for reimbursement. Reimbursements are also required to be paid within 15 days of the resident belongings removed from the home.

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 designee . Copy of this report and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250626141112
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: RNCARE HOUSE @ EAST ROSEVILLE
FACILITY NUMBER: 312700888
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2025
Section Cited
CCR
87468.2(a)(20
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Additional Personal Rights of Residents in Privately Operated Facilities (a)(20) To be protected from involuntary transfers, discharges, and evictions. This requirement was not met based on records and statements. This posed a risk to resident’s rights.
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POC- licensee will submit a procedure for reappraisal and arrangement for transfer when a resident is deemed to require a higher level of care. POC due 9/2/25.
Type B
09/02/2025
Section Cited
CCR
87505(g)(5)(A)
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Admission Agreements (g)5) Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned…A refund of any fees … within 15 days after the personal property is removed. This requirement was not met based on records and statements. This posed a risk to resident’s rights.
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POC- an accounting of fees paid, daily rate (based on 30 day month), and calculation of refund owed as well as proof of reconciling money owed if applicable. POC due 9/2/25.
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This requirement was not met based on records and statements. This posed a risk to resident’s rights.
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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: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025
LIC9099 (FAS) - (06/04)
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