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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700589
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:55:46 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2023 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230213093535
FACILITY NAME:SKYE LUIS CARE HOMEFACILITY NUMBER:
342700589
ADMINISTRATOR:RODRIGUEZ, ANNIE LYNFACILITY TYPE:
740
ADDRESS:8705 GREAT CTTELEPHONE:
(916) 685-6910
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 4DATE:
03/09/2023
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Facility StaffTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff handled resident in a rough manner.
Facility staff sexually abused resident while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to deliver complaint investigation findings. LPA met with facility staff, and explained the purpose of the visit.

The department interviewed resident 1's responsible parties. All 3 individuals do not believe the allegations are true. R1 has advanced Dementia and is known to say things that do not occur. According to Elk Grove Police records, EGPD conducted a investigation and concluded unfounded. The case was closed due to lack of evidence. According to medical records, resident 1 was taken to the hospital due to facility staff notifying blood in R1s stool during a diaper change. Medical records show two diagnosis with one having symptoms including delusions. According to interviews with social worker and responsible party, resident makes frequent similar accusations day to day and rescinds those accusations. R1 was discharged back to Skye Luis Care Home. Based on evidenced and statements gathered, there is no evidence to show that the allegations were true. The allegations are unfounded. An exit interview was held with Administrator Annie via cell, and a copy of the report was provided to facility staff at the facility.


Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023
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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