315920297-1-13-2026-59-AS-MSEY-DQBQAV-20260114110034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315920297
Report Date: 01/13/2026
Date Signed: 01/13/2026 09:55:51 AM

Unsubstantiated

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
11/18/2025 and conducted by Evaluator Melissa Parks

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20251118091014

FACILITY NAME:	A LOVING SENIOR CARE HOME II LLC		FACILITY NUMBER:	315920297
ADMINISTRATOR:	TEANG, SREY T.		FACILITY TYPE:	740
ADDRESS:	1190 EARLTON LANE		TELEPHONE:	(209) 640-1619
CITY:	LINCOLN	STATE: CA	ZIP CODE:	95648
CAPACITY:	6	CENSUS: 6	DATE:	01/13/2026
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Srey Teang		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not answer residents calls for assistance during the night

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday January 13, 2026, to conclude a complaint investigation regarding the above allegation. LPA met with Administrator Srey and explained the purpose of the visit.

LPA interviewed staff who stated that residents press their call buttons or staff do routine checks on residents. According to the complainant, R1 had a fall which the staff did not respond to timely. LPA interviewed staff who stated that R1 did not have a fall during the month of November. Staff stated that R1 requires frequent checks due to R1's Dementia. LPA reviewed R1’s hospice progress notes. Progress notes did not mention any bruise, evidence of a fall, or any complaints of pain.

Based on information obtained during the investigation, LPA finds the allegation to be 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 evidence to prove that the alleged violation occurred.
Exit interview. A copy of this report was provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2026

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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