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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 12/19/2024
Date Signed: 12/19/2024 02:19:27 PM

Unfounded


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
12/18/2024 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20241218125105
FACILITY NAME:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:CLARK, TIMOTHYFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 4DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not have required first aid training
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 12/19/24 at 12:30pm to conduct an investigation of the above mentioned allegation. Upon arrival LPA met with Administrator Beatrice Clark and stated the purpose of the visit. LPA requested to review staff #1 (S1) file during this visit. LPA provided a copy of the LIS printout for staff clearances. LPA observed that S1 is finger print cleared and associated to the home. Upon a file review LPA observed that S1 has a CPR/First Aid certificate dated 4/5/24 which is valid for 2 years. LPA also observed other documented trainings that S1 has completed and a Nursing Assistant certificate valid until 8/19/25 for Washington State Department of Health.
Based on interview, documentation, and that there was no incident that occurred which warranted S1 to provide CPR/First aid, the allegation is deemed Unfounded. "The allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint." Per California Code of Regulations, no deficiencies were observed or cited. Exit interview held, and a copy provided.
Unfounded
Estimated Days of Completion: 30
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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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