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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700018
Report Date: 09/16/2025
Date Signed: 09/16/2025 04:47:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
01/06/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250106153318
FACILITY NAME:GROVE HOME CAREFACILITY NUMBER:
342700018
ADMINISTRATOR:BOBOC, LUCIAFACILITY TYPE:
740
ADDRESS:8410 TERRACOTTA CIRCLETELEPHONE:
(916) 225-6405
CITY:SACRAMENTOSTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lucia BobocTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
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8
9
Untrained staff providing care to resident
Staff are not providing adequate food service to resident
Staff did not safeguard resident's personal belongings
Staff are mismanaging resident's medication
INVESTIGATION FINDINGS:
1
2
3
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5
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13
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski met with facility administrator Lucia Boboc and explained the purpose of the visit.

This investigation consisted of interviews, record review, and observation.

In interviews, a staff member (S3), a resident (R1), and a resident's responsible party (R1's RP) said there was a certain staff person working at this facility as a caregiver around December 2024 or January 2025, and identified this person by name (S4). Boboc was not familiar with any staff person by that name. Boboc reviewed Guardian records and was not able to identify this staff person among either active or separated employees. LPA Moleski asked for this staff person's file. Boboc did not have a file available for review. [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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 8
Control Number 27-AS-20250106153318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROVE HOME CARE
FACILITY NUMBER: 342700018
VISIT DATE: 09/16/2025
NARRATIVE
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22 CCR Section 87412(h) requires personnel records to be maintained for at least three years following termination of employment. Additionally, 22 CCR Section 87411(c)(6) requires the licensee to "maintain documentation pertaining to staff training in the personnel records..."

LPA Moleski reviewed R1's LIC 602, dated 11/10/23, prior to R1's admission date of 12/6/23. LPA Moleski observed that many fields of required information, including information regarding any potential medically ordered restricted diets, were not completed. The LIC 602 indicated there was an "additional patient response" form attached to the LIC 602 with the information. This additional patient response form was not included in R1's file. LPA Moleski asked Boboc if she had a copy of the patient response form. Boboc said she never had a copy of the patient response form. LPA Moleski pointed out that she had accepted a resident without full information regarding their medical needs. Boboc acknowledged this and said she was not aware of this at the time. Without a physician's order on file, licensees, staff, or attorneys-in-fact may not restrict a resident's right to personal preferences regarding meals. However, in interviews, Boboc said they had restricted R1's diet at the request of R1's attorney-in-fact (R1's RP). Boboc said this was distressing to R1, who did not understand why they could not eat what other residents were eating. In an interview, R1 voiced no concerns with the quality of food served at this facility.

In interviews, both R1 and R1's RP said that staff had removed decorations from R1's room. R1 said that staff "tore" the decorations down. In an interview, Boboc said she didn't know what had happened, as she was not present. LPA Moleski was unable to contact the staff person who was working at the time. Boboc said she did not know who was on duty at the time. S3 said that they started working at the facility after S4 left, around late December 2024 or early January 2025, and at that point, the decorations had been put back up.

This facility does not keep daily medication administration records. LPA Moleski performed an audit of medications during this visit, and observed physician's orders were not being followed. LPA Moleski observed a blood pressure medication, one tablet of which was to be given twice daily, unless blood pressure was too low or unless heart rate was below 55. LPA Moleski observed a start date for this medication of 9/6/25. LPA Moleski counted out the remaining tablets and observed that the medication had consistently been given twice daily since that date. However, LPA Moleski observed several days since that date wherein R1's heart rate was recorded below 55, meaning that the medication should have been held per the prescription orders. [continued on 9099-C]
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
01/06/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250106153318

FACILITY NAME:GROVE HOME CAREFACILITY NUMBER:
342700018
ADMINISTRATOR:BOBOC, LUCIAFACILITY TYPE:
740
ADDRESS:8410 TERRACOTTA CIRCLETELEPHONE:
(916) 225-6405
CITY:SACRAMENTOSTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lucia BobocTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not abiding by resident's admissions agreement
Staff are making inappropriate comments towards resident
Staff are harassing resident
Staff did not ensure resident was showered
Staff left resident in soiled diaper for extended period of time
Staff are not following resident's dietary needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski met with facility administrator Lucia Boboc and explained the purpose of the visit.

LPA Moleski reviewed R1's LIC 602, dated 11/10/23, prior to R1's admission date of 12/6/23. LPA Moleski observed that many fields of required information, including information regarding any potential medically ordered restricted diets, were not completed. The LIC 602 indicated there was an "additional patient response" form attached to the LIC 602 with the information. This additional patient response form was not included in R1's file. LPA Moleski asked Boboc if she had a copy of the patient response form. Boboc said she never had a copy of the patient response form. LPA Moleski pointed out that she had accepted a resident without full information regarding their medical needs. Boboc acknowledged this and said she was not aware of this at the time. Without a physician's order on file, licensees, staff, or attorneys-in-fact may not restrict a resident's right to personal preferences regarding meals. [continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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 8
Control Number 27-AS-20250106153318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROVE HOME CARE
FACILITY NUMBER: 342700018
VISIT DATE: 09/16/2025
NARRATIVE
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Although the licensee should have sought to acquire all pertinent medical information before admission, they cannot be held accountable for adhering to physician's orders which they were not provided. LPA Moleski will address the licensee's failure to acquire this crucial medical information in a separate case management report.

LPA Moleski reviewed R1's admission agreement. LPA Moleski observed numerous modifications in this agreement made by R1's RP. Boboc signed the agreement, which makes all modifications enforceable. However, LPA Moleski did not observe any such provision, modified or otherwise, which would require that only female staff provide care for R1. However, LPA Moleski observed that R1's resident appraisal, signed by Boboc on 12/15/23, does indicate that R1 shall have "female staff only -- especially for intimate care." In an interview, R1 said they are only cared for by female staff. In interviews, S1-S3 said that R1 is only cared for by female staff.

In an interview on 1/9/25, R1 said that staff are not harassing them, and said that staff do not speak inappropriately to them. R1 said that they regularly receive showers twice per week. R1 said they can "holler" for staff if they need assistance at night, but they don't always ask for it. R1 voiced no concerns with the quality of food served in this facility. In an interview on 9/16/25, R1 said that they are not changed frequently enough. However, R1 also said all their needs were being met and said that they do not always let staff know when they need assistance with diaper changes. LPA Moleski reviewed R1's functional capabilities assessment, dated December 2023, and observed that R1 is fully able to express themselves verbally, and has some bladder and bowel control. R1's LIC 602, dated 11/6/23, indicates that R1 does not suffer from mild cognitive impairment or dementia. R1's preadmission appraisal, dated December 2023, does not indicate that R1 needs special overnight supervision.

In interviews, S1-S3 said they had not witnessed any sort of harassment or inappropriate comments being made toward R1. In interviews, the other residents of this facility, R2-R5, did not voice any concerns regarding medications, harassment, inappropriate comments, showers, or diaper changes. R2, who does not have a dementia diagnosis, said that their diapers are changed as frequently as necessary, and said that they are able to get nighttime assistance without issues.

LPA Moleski observed that, starting in June, facility staff began documenting R1's daily care to ensure consistency. During this visit, all residents appeared clean and cared for. [continued on 9099-C]
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 27-AS-20250106153318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROVE HOME CARE
FACILITY NUMBER: 342700018
VISIT DATE: 09/16/2025
NARRATIVE
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The department has determined the following as it relates to the allegations that staff are not abiding by a resident's admissions agreement, that staff are making inappropriate comments towards a resident, that staff are harassing a resident, that staff did not ensure a resident was showered, that staff left a resident in a soiled diaper for an extended period of time, and that staff are not following a resident's dietary needs:

Based on interviews, observations, and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited regarding the above allegations. An exit interview was held and a copy of this report was left with Boboc.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 27-AS-20250106153318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GROVE HOME CARE
FACILITY NUMBER: 342700018
VISIT DATE: 09/16/2025
NARRATIVE
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The department has determined the following as it relates to the allegations that untrained staff are providing care to a resident, that staff are not providing adequate food service to a resident, that staff did not safeguard a resident's personal belongings, and that staff are mismanaging a resident's medication

Based on interviews, observation, record review the above allegations are SUBSTANTIATED. A finding that the complaint allegations are substantiated means that the allegations are valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Sections 87555(b)(5), 87411(c)(6), 87217(b), and 87465(a)(4). An exit interview was held with Boboc. Appeal rights and a copy of this report were left with Boboc.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 27-AS-20250106153318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROVE HOME CARE
FACILITY NUMBER: 342700018
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2025
Section Cited
CCR
87555(b)(5)
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"(5) Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents." This requirement was not met as evidenced by:
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7
Licensee agrees to review the powers granted to R1's attorney in fact, and to review residents' rights by POC due date. Licensee shall provide LPA Moleski with a signed statement acknowledging this has been completed.
vincent.moleski@dss.ca.gov
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Based on interviews, staff members restricted R1's diet without physician's orders to do so, in violation of residents' rights, which poses a potential health, safety, and/or personal rights risk to residents.
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Type B
09/23/2025
Section Cited
CCR
87411(c)(6)
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"(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer." This requirement was not met as evidenced by:
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Licensee agrees to provide LPA Moleski with a signed acknowledgement that they will be aware of which staff members are working in their facility, and that they will ensure proper documentation remains on file for all such persons, by POC due date.
vincent.moleski@dss.ca.gov
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Based on three witness statements, a staff member worked in this facility for whom no file can be located, and no training records are available. This poses a potential health, safety, and/or personal rights 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: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 27-AS-20250106153318
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GROVE HOME CARE
FACILITY NUMBER: 342700018
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/17/2025
Section Cited
CCR
87465(a)(4)
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7
"(4) The licensee shall assist residents with self-administered medications as needed." This requirement was not met as evidenced by:
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Licensee agrees to submit a signed acknowledgement that physician's orders shall be followed exactly as written in the future by POC due date.
vincent.moleski@dss.ca.gov
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14
Based on observation and interview, a resident's medication was being improperly dispensed, which poses an immediate health, safety, and/or personal rights risk.
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14
Type B
09/30/2025
Section Cited
CCR
87217(b)
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"(b) Every facility shall take appropriate measures to safeguard residents' ... personal property ... which have been entrusted to the licensee or facility staff." This requirement was not met as evidenced by:
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Licensee agrees to provide LPA Moleski with a signed statement acknowledging that residents' belongings are not to be disturbed without their consent by POC due date.
vincent.moleski@dss.ca.gov
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Based on interviews, a resident's personal property was improperly removed without consent of the resident, which poses a potential health, safety, and/or personal rights 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: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8