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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701059
Report Date: 08/29/2025
Date Signed: 09/02/2025 03:35:12 PM

Unsubstantiated


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
08/25/2025 and conducted by Evaluator Kevin Gould
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250825161456
FACILITY NAME:AMAZING GRACE ELDER CARE #2FACILITY NUMBER:
342701059
ADMINISTRATOR:MATIAS, PATRICIAFACILITY TYPE:
740
ADDRESS:7723 EL RITO WAYTELEPHONE:
(916) 329-8745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY:6CENSUS: 6DATE:
08/29/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nate SterlingTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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1) Staff does not maintain a comfortable room temperature for residents.
2) Staff gives residents another resident’s food.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Amazing Grace Elder Care #2 RCFE on 8/29/25 at 11:30am to inform the licensee of complaint allegations mentioned above.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA immediately checked the facility thermostat and observed a temperature of 71 degrees that meets title 22 regulations. LPA observed the facility to be comfortable and reasonable temperature given the time of day and season. LPA inspected the food supply and observed adequate supply of perishable and non-perishable foods. LPA observed staff members preparing a fresh lunch. LPA observed a food supply of frozen burritos and taco stored in the fridge. LPA informed staff for food safety items must be stored as directed. Staff informed LPA that food supplies belong to R1 and will be upset if moved. Report Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
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 27-AS-20250825161456
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: AMAZING GRACE ELDER CARE #2
FACILITY NUMBER: 342701059
VISIT DATE: 08/29/2025
NARRATIVE
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LPA Gould met with R1 and attempted to explain the purpose of visit. LPA began to question R1 regarding food supply and R1's concern with food. R1's statements to LPA were not corroborated by LPAs observations of food supply. R1 grew increasingly agitated in LPAs presence and LPA exited the facility for safety purposes and R1 followed LPA to their vehicle. R1 was redirected inside by staff members.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of personal rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies is cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2