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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920037
Report Date: 02/18/2026
Date Signed: 02/18/2026 02:33:34 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
02/12/2026 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20260212093422
FACILITY NAME:SAPPHIRE SENIOR CAREFACILITY NUMBER:
315920037
ADMINISTRATOR:TULENINOVA, NATALIAFACILITY TYPE:
740
ADDRESS:667 GRIDER DRIVETELEPHONE:
(279) 900-8903
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 6DATE:
02/18/2026
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:caregiver S1TIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff did not abide to the admission agreement
INVESTIGATION FINDINGS:
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On 2/18/26, Licensing Program Analyst (LPA) Kevin Mknelly spoke with care giver S1 who notified Natalia Tulenenova. Natatia arrived for LPA to investigate and to deliver complaint findings for the above allegation.

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

R1 was admitted to te facility while in hospice care on 11/22/25. R1 passed away on 11/25/25. R1's belongings were removed from the facility on 11/25/26 . To date, R1's representaives were not reimbursed for the balance for fees paid for Nov. 2024. Therefore R1's representative is owed a refund

As a result of this investigation, LPA finds allegation to be (S) Substantiated -

Report reviewed with Natalia . Copy of this report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
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 2
Control Number 59-AS-20260212093422
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: SAPPHIRE SENIOR CARE
FACILITY NUMBER: 315920037
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2026
Section Cited
HSC
1569.652(a)
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(a) A residential care facility for the elderly shall not require advance notice for terminating an admission agreement upon the death of a resident. No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit.
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Licensee will submit proof of reimbursement by the POC date of 3/4/26
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This requirement was not met based on records and statement. This posed a potential risk
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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: 02/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2