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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920211
Report Date: 10/23/2025
Date Signed: 10/23/2025 03:40:51 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
10/07/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20251007163437
FACILITY NAME:MILLPORT VILLASFACILITY NUMBER:
315920211
ADMINISTRATOR:AREFA, NEGASHFACILITY TYPE:
740
ADDRESS:7641 MILLPORT DRIVETELEPHONE:
(916) 472-6669
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 5DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Schvonda Peter-RobertsonTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff refusing to pick up resident’s medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 On 10/23/25, Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with designee to deliver investigation findings.
LPA reviewed resident records, facility records, and conducted interviews.
LPA finds that facility met Tittle 22 requirements.
R1 was reportedly requested to ask family to pick-up medciations. Medciation supply had not run out at that time. Family did pick-up R1 pain meds and gave them to R1. R1 is designated by their physician as being capable to administrer PRN medications and is not self administering pair medication. Facility staff picked up and centrally stored R1's additional medication. R1 did not have any missed medication due to lack of availablilty.
This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and report provided.
Unfounded
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Kevin Mknelly
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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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