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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 06/03/2025
Date Signed: 06/03/2025 12:25:13 PM

Substantiated


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
09/27/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240927111732
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:
06/03/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Beatrice ClarkTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff do not ensure that residents in care are provided with food that is of good quality.
Staff do not provide activities for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Beatrice Clark and explained the purpose of the visit.
This investigation consisted of interviews, observation, and record review. LPA Moleski reviewed six residents’ files (R1-R2 and R4-R7). LPA Moleski interviewed two staff members (Clark and S3), six residents (R1-R2 and R4-R7), and four residents’ responsible parties (R1’s RP, R4’s RP, R5’s RP, and R7’s RP).

During a visit to this facility on 10/2/24 Community Care Licensing Division (CCLD) staff observed food that was undated, leftover food covered with plates, leftover food which was uncovered, and open smoothie container. [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 5
Control Number 27-AS-20240927111732
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: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
VISIT DATE: 06/03/2025
NARRATIVE
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During a visit to this facility on 3/7/25, CCLD staff observed food which was improperly covered, insufficient food supplies, unclean refrigerators, and freezer burned food. In recent interviews, a resident (R1) said the facility’s food had been “poor quality” several months ago, but had since improved.

LPA Moleski visited this facility during daytime hours on 5/5/25 for a period of approximately 6.5 hours. LPA Moleski visited this facility a second time during daytime hours on 5/20/25 for a period of approximately 5.5 hours. During these time periods, LPA Moleski did not observe most residents engaged in meaningful activities. LPA Moleski did observe one resident with dementia playing with sensory stimulation devices, but did not observe any other group or individual activities ongoing. Residents observed during these time periods were largely either watching television or sitting outside. LPA Moleski interviewed two residents who were able to coherently respond to questions and who were not diagnosed with any sort of cognitive impairments (R2 and R7). R2 said that there are board games at the facility, but they are not played. R2 did not identify any other activities that are available for residents. R2 said that activities are not possible due to the condition of the other residents of the facility. R7 also said there are games around the facility, but they are not used. R7 had not observed other residents engaged in meaningful activities. LPA Moleski interviewed a staff member (S3) on the same date LPA Moleski interviewed R7. S3 claimed that a board game had been played with residents the day before. In an interview, R6’s RP said that there was “not a lot of stimulation” at the facility, that staff “don’t seem to engage them in activities,” and that when they visit, R6 is typically watching television.

The department has determined the following as it relates to the allegations that staff do not ensure that residents in care are provided with food that is of good quality and that staff do not provide activities for residents in care:

Based on interviews and observations, the above allegations are SUBSTANTIATED. A finding that the complaint allegations are substantiated means that the allegations are valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Sections 87555(a) and 87219(a). An exit interview was held with Clark. Appeal rights and a copy of this report were left with Clark.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/27/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240927111732

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: 5DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Beatrice ClarkTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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2
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9
Staff do not ensure residents have clean linens.
Staff do not assist residents with their ADLs.
Staff do not assist residents with toileting.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Beatrice Clark and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review. LPA Moleski reviewed six residents’ files (R1-R2 and R4-R7). LPA Moleski interviewed two staff members (Clark and S3), six residents (R1-R2 and R4-R7), and four residents’ responsible parties (R1’s RP, R4’s RP, R5’s RP, and R6’s RP).

LPA Moleski visited this facility during daytime hours on 5/5/25 for a period of approximately 6.5 hours. LPA Moleski visited this facility a second time during daytime hours on 5/20/25 for a period of approximately 5.5 hours. [continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240927111732
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: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
VISIT DATE: 06/03/2025
NARRATIVE
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During this time period, LPA Moleski did not smell any odors of urine or feces from residents or from their bedrooms. LPA Moleski did observe staff assisting residents to the bathroom in order to care for their continence needs, and otherwise observed residents being assisted with their activities of daily living (ADLs). LPA Moleski observed residents’ clothing and bed linens to be clean.

LPA Moleski interviewed four residents who were able to respond verbally and coherently (R1, R2, R6, and R7). Of these, two were not diagnosed with any sort of cognitive impairments (R2 and R7). R1 voiced no concerns with their quality of care, and said they receive all assistance when needed. R2 voiced no concerns with quality of care, and said that other residents are cared for appropriately by staff, such as ensuring that they are bathed and that their diapers are changed regularly. R6 voiced no concerns with their quality of care and said they had their basic needs met. R7 said that although they did not receive showers, they do receive bed baths on a regular basis. R7 said they receive assistance with other ADLs when requested.

In interviews, four residents’ responsible parties (R1’s RP, R4’s RP, R5’s RP, and R6’s RP) voiced no significant concerns with the quality of direct care at the facility.

The department has determined the following as it relates to the allegations that staff do not ensure residents have clean linens, that staff do not assist residents with their ADLs, and that staff do not assist residents with toileting:

Based on interviews and observations, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited regarding the above allegations. An exit interview was held and a copy of this report was left with Clark.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240927111732
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: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2025
Section Cited
CCR
87555(a)
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“(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.” This requirement was not met as evidenced by:
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Licensee agrees to provide LPA Moleski with an inservice training record by POC due date.
vincent.moleski@dss.ca.gov
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Based on interviews and observations, food was not stored or prepared in a safe and healthful manner, which poses a potential health, safety, and/or personal rights risk.
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Type B
06/09/2025
Section Cited
CCR
87219(a)
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“(a) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include:” This requirement was not met as evidenced by:
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Licensee agrees to provide LPA Moleski with a planned activities calendar to be used daily, with all refusals documented, by POC due date.
vincent.moleski@dss.ca.gov
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Based on interviews and observations, residents were not encouraged to participate in a variety of planned activities, which poses a potential health, safety, and/or personal rights risk.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5