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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700984
Report Date: 10/30/2024
Date Signed: 10/30/2024 02:18:15 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
08/26/2024 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20240826112643
FACILITY NAME:SYCAMORE RESIDENTIAL CARE CENTER, B LLCFACILITY NUMBER:
342700984
ADMINISTRATOR:NASSAR, NADERFACILITY TYPE:
740
ADDRESS:4545 SYCAMORE AVENUE, UNIT BTELEPHONE:
(916) 333-2751
CITY:SACRAMENTOSTATE: CAZIP CODE:
95841
CAPACITY:6CENSUS: 6DATE:
10/30/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:CaregiverTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 On 10/30/24, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with caregiver/ designee, Mia Alvarado.
LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.
It was alleged that a caregiver, S1, while staff approached R1 to hand R1 a phone that S1 grabbed R1's right shoulder. Interview with R1 with R1 was very inconsistent and about when and how S1 was to have grabbed R1. Furhtermore, R1, made additional statements that showed misrepresentation of R1's abilities and perceptions of others. Interviews with staff and other residents found no witnesses to inappropriate behaviors by S1 toward other residents.
As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview conducted and report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024
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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