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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700184
Report Date: 03/30/2026
Date Signed: 03/30/2026 09:40:45 AM

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
01/06/2026 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 59-AS-20260106101405
FACILITY NAME:SHEARWATER RESIDENCEFACILITY NUMBER:
342700184
ADMINISTRATOR:THOMAS, REBECCAFACILITY TYPE:
740
ADDRESS:6526 MAIN AVETELEPHONE:
(916) 989-1060
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:16CENSUS: 10DATE:
03/30/2026
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Med Tech , Ayanna ThompsonTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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Staff financially abused resident in care.
INVESTIGATION FINDINGS:
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On 3/30/26, Licensing Program Analyst (LPA) Talwinder Bains arrived unannounced to deliver complaint findings for allegations listed above. LPA met with staff during today's visit and explained the purpose of the visit. LPA spoke with administrator, Rebecca Thomas via phone who gave permission to coduct today's visit with staff, Med Tech Ayanna Thompson.

The Department conducted a financial audit and found that staff, S1 financial abused resident, R1 by using R1’s bank card to make unauthorized personal purchases. R1 has a diagnosis of dementia and does not have the capacity to give consent. R1’s bank records showed $351.41 in successful charges made and $869.96 in attempted charges. Video surveillance obtained shows S1 using R1’s bank card to make purchases. Once the licensee was made aware of the fraudulent charges on R1’s bank card, the licensee terminated S1 and notified the licensing office. Based on the documentation and video surveillance obtained, S1 falsely used R1’s bank card to make unauthorized personal purchases.
Based on the information gathered, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached LIC 9099-D page.

Exit interview conducted. Appeal rights and a copy of this report were provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
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-20260106101405
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: SHEARWATER RESIDENCE
FACILITY NUMBER: 342700184
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/31/2026
Section Cited
CCR
87217(f)
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87217- Safeguards for Resident Cash, Personal Property, and Valuables
(f) No licensee or employee of a facility shall make expenditures from residents' cash resources for any basic service specified in this Chapter, or for any basic services identified in a contract/admission agreement between the resident and facility....this requirement was not as evidenced by;
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Licensee/Administrator shall send a letter of understanding of this Regulation and shall conduct all staff training. All POC documents are due by 3/31/26.
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Based on the documentation and video surveillance obtained, staff, S1 falsely used resident, R1’s bank card to make unauthorized personal purchases, which poses a immediate health and safety risks to residents in care.
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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: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2