315002855-9-25-2025-59-AS-LMUZ-DLZQBR-20250930120158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002855
Report Date: 09/25/2025
Date Signed: 09/25/2025 10:46:20 AM

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
07/15/2025 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 59-AS-20250715102317

FACILITY NAME:	DOLCE VITA HOME CARE		FACILITY NUMBER:	315002855
ADMINISTRATOR:	NATALYA ANDREYEA		FACILITY TYPE:	740
ADDRESS:	141 HINCKLEY CT		TELEPHONE:	(916) 521-5393
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95747
CAPACITY:	6	CENSUS: 6	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Natalya Andreyea		TIME COMPLETED:	10:55 AM

ALLEGATION(S):

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Staff imposed restrictions on resident’s visits.
Staff did not allow resident to receive telephone calls.
Staff served as resident’s agent under a power of attorney document.

INVESTIGATION FINDINGS:

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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Natalya Andreyea to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, 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: 10

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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-20250715102317

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: DOLCE VITA HOME CARE	FACILITY NUMBER: 315002855
	VISIT DATE: 09/25/2025

NARRATIVE

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Staff imposed restrictions on resident’s visits.

Interviews conducted with the administrator indicated that resident R1 was allowed to have visitors. R1 had visitors and was able to leave the facility with the visitors for outings. Interviews with R1 indicated that they had had visitors while living at the facility. Interviews with staff indicated that R1 did not have many visitors but those who came were able to see R1. Records reviewed indicated that the visitor log had been signed and indicated that R1 had visitors on occasion. Therefore, the allegation staff imposed restrictions on resident’s visits is unfounded.

Staff did not allow resident to receive telephone calls.

Interviews conducted with staff indicated that resident R1 was allowed to receive phone calls from guests. Interviews with administrator indicated that R1 was able to receive phone calls but explained that when calls were received late at night from guests, she would not wake up R1 for the phone calls and encouraged guests to call during visiting hours. Interviews with R1 indicated that they were able to make and receive phone calls. R1 did not feel that their calls were restricted in any way. Therefore, the allegation staff did not allow resident to receive telephone calls is unfounded.

Staff served as resident’s agent under a power of attorney document.

Records reviewed indicated that resident R1 had a power of attorney in place through an individual who had no relation to the current facility. Interview with administrator indicated that due to R1’s physical status, it was advised that R1 had a power of attorney in place for financial assistance. R1 had chosen their own power of attorney and administrator assisted in getting all the paperwork completed. Therefore, the allegation staff served as resident’s agent under a power of attorney document is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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