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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700012
Report Date: 03/17/2026
Date Signed: 03/17/2026 12:39:58 PM

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
12/29/2025 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20251229130101
FACILITY NAME:TWIN RIVERS AT NATOMASFACILITY NUMBER:
342700012
ADMINISTRATOR:SITA VADAREVUFACILITY TYPE:
740
ADDRESS:421 SAN JUAN ROADTELEPHONE:
(916) 216-3058
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:48CENSUS: 40DATE:
03/17/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Sita VadarevuTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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9
1. Facility is malodorous.
2. Facility is not ensuring that residents utilize resident's assistive devices.
3. Facility staff are not ensuring to protect resident's property.
INVESTIGATION FINDINGS:
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LPA Hiratsuka conducted the investigation into the allegations above.

LPA Hiratsuka conducted interviews, reviewed files, and walked around.

1. LPA observed one resident's room to have a urine smell. LPA observed staff were still in the process of cleaning resident rooms. Once the bed was changed the smell disapated. Staff stated they check on residents every two hours or as needed and this one room both residents can be difficult with assistance to use the bathroom and incontinent care during the hours the residents sleep. LPA and administrator discussed options and other ways to assist the residents with incontinent care. LPA cannot prove or disprove the staff are not keeping the facility free of odors due to not cleaning. LPA did not observe any other issues with the physical plant.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
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 3
Control Number 59-AS-20251229130101
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: TWIN RIVERS AT NATOMAS
FACILITY NUMBER: 342700012
VISIT DATE: 03/17/2026
NARRATIVE
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2. and 3. LPA interviewed the resident in question. The device in question is a pair of glasses. The staff stated the resident does not like wearing glasses. LPA observed the resident doing an activity and did not appear to require glasses for the activity. LPA asked the resident if they wanted to put their glasses on the and the resident said no. LPA observed the resident walking around and not bumping into things. Staff stated the resident will put on the glasses if reminded but will take them off very shortly or sometimes refuse to wear them. Staff stated the resident also misplaces the glasses and won't tell the staff where the glasses are. LPA observed the staff this morning looking for the glasses. The staff stated the resident takes them off and puts them wherever they choose. Staff stated they know the resident wore them the other day and has not gone anywhere. Staff stated they check the trash cans before the trash is thrown out. LPA cannot prove or disprove staff do not assist the resident with wearing the glasses or safeguards the glasses based on the resident's capabilities. LPA and administrator discussed several ways to document resident abilities and capabilities with adaptive devices.



Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
12/29/2025 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20251229130101

FACILITY NAME:TWIN RIVERS AT NATOMASFACILITY NUMBER:
342700012
ADMINISTRATOR:SITA VADAREVUFACILITY TYPE:
740
ADDRESS:421 SAN JUAN ROADTELEPHONE:
(916) 216-3058
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:48CENSUS: 40DATE:
03/17/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Sita VadarevuTIME COMPLETED:
12:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not following admission agreement.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Hiratsuka arrived unannounced at the facility to deliver the results of the allegation above.

LPA reviewed the admission agreement. Per state and federal law, when the resident is a SSI/SSP recipient, when the provision of SSI/SSP rate changes for the recipient, the licensee may increase the rate the recipient pays to the facility the date the increase becomes effective. The licensee gave the responsible party notice of the rate increase three days prior to the effective date based on when Social Security released their notice of increasing the payments to the recipients.

Based on information above, the department concluded that the allegations are Unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.
no deficiencies cited
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3