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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700763
Report Date: 11/05/2025
Date Signed: 11/05/2025 10:00:37 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, 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
08/25/2025 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20250825132401
FACILITY NAME:A-1 ELDERLY CAREFACILITY NUMBER:
342700763
ADMINISTRATOR:TIF, ROBERTFACILITY TYPE:
740
ADDRESS:5210 ROBERTSON AVETELEPHONE:
(916) 996-4763
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Robert Tif, AdministratorTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Staff did not ensure that the resident's grooming care needs were properly met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to investigate complaint. LPA met with Administrator Robert Tif during today’s inspection.

The department investigated allegation, “Staff did not ensure that the resident's grooming care needs were properly met”. The department interviewed residents, staff and relevant parties. Reporting Party indicated R1 had unkempt finger nails and dry skin. The department interviewed responsible party of R1 and they stated they were happy with the care being provided to R1 from the facility. R1 had health issues which caused their hand to be curved and it made it difficult to keep their fingernails cut. Responsible party had R1’s fingernails cut by a nail stylist shortly after complaint was made. R1 was on and off hospice care and receiving care from the hospice team. LPA toured the facility and observed residents to appear clean and groomed properly. LPA observed the facility to be clean and free from smell.
CONTINUATION ON 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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 2
Control Number 59-AS-20250825132401
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: A-1 ELDERLY CARE
FACILITY NUMBER: 342700763
VISIT DATE: 11/05/2025
NARRATIVE
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LPA reviewed hospice and facility documentation. LPA observed in hospice documents that hospice aide came to facility 2x weekly to perform bathing and personal care to resident. Documents indicate hospice aide performed nail filing on fingernails for resident.

Due to the information gathered, LPA finds allegation UNSUBSTANTIATED. 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.

Exit interview was conducted and copy of report provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2