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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 10/27/2025
Date Signed: 10/27/2025 03:51:46 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
10/14/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251014094455
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: 6DATE:
10/27/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Leashia Tyrell-MooreTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not serve residents food of good quality
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski spoke with facility administrator Beatrice Clark over the phone and explained the purpose of the visit.

During this visit, LPA Moleski inspected food storage areas. LPA Moleski observed several opened containers of food in these storage areas, including perishable foods. LPA Moleski observed an unsealed package of pancake mix, a bag of snack crackers without a twist tie or clip, an open bag of corn meal inside of an open box, an open bag of corn flour without a twist tie or clip, an unsealed bag of sweetener, an open bag of cereal inside of an open box, a bag of oatmeal without a twist tie or clip, and an unsealed plastic zip-lock bag of leftover halved onions and bell peppers. LPA Moleski also observed one half of a green bell pepper lying cut-side down in a vegetable drawer. The bell pepper was not stored in any sort of container. [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
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
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
10/14/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251014094455

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: 6DATE:
10/27/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not assist resident with showering
Staff do not assist resident with ambulating
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski spoke with facility administrator Beatrice Clark over the phone and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review. Two staff members and five residents were interviewed.

During this visit, LPA Moleski observed both staff members on duty operate a Hoyer lift to transfer a resident (R6) out of bed and into a wheelchair in order to prepare R6 for a medical appointment. Both staff members were physically capable of assisting R6 with the transfer, and appeared sufficiently competent to complete the transfer without issues. [continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20251014094455
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: 10/27/2025
NARRATIVE
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In an interview, R6 said staff assist them with dressing, showering, and with transferring. R6 said they cannot stand on their own, but said that staff do try to help them using the Hoyer lift. When asked, R6 said that they had not received a shower within the past week, but said that staff do provide bed baths in order to meet their hygiene needs. R6 was not able to recall when they had last received a bed bath. R6 appeared clean, and did not present any odors indicating their hygiene needs were not being met.

In interviews, caregivers C1 and C2 said that R6 does not always want to get up out of bed, and when R6 does get out of bed, they often want to return to bed shortly afterward. C1 said that R6 receives daily bed baths. C2 initially said that R6 receives bed baths every other day, but later said that R6 receives bed baths daily.

LPA Moleski interviewed R6's responsible party (R6's RP) over the phone during this visit. R6's RP was aware that R6 receives bed baths, and expressed no concern with this accommodation. R6's RP said that R6 has numerous medical conditions which make it difficult to move around. R6's RP said they have witnessed staff transferring R6 previously.

In an interview, R6's roommate, R2, did not voice concerns regarding R6's care. R2, who moved into this facility in September, said they did observe odorous residents around the time R2 moved in, but R2 said this was the choice of those residents. Per 22 CCR Section 87468.1(a)(16), residents retain the right to refuse any service, including hygiene care. R2 said that they have not observed any issues since then. R2 said they regularly observe staff transferring other residents up out of bed.

The department has determined the following as it relates to the allegations that staff do not assist a resident with showering and that staff do not assist a resident with ambulating:

Based on interviews and observation, 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 these allegations. An exit interview was held with Clark. A copy of this report was left with staff member Leashia Tyrell-Moore.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
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Control Number 27-AS-20251014094455
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: 10/27/2025
NARRATIVE
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During a visit on 10/16/25, LPA Sommer Hayes observed a child visitor accompanied by Clark. LPA Hayes observed the child roaming around the facility and touching fruit sitting on the kitchen counter. On that same date, LPA Hayes observed raw shredded cabbage without dressing served as a side salad. In an interview conducted by LPA Hayes, R2 reported that hot dog buns had been used for sandwiches, as staff had run out of sliced bread.

22 CCR Section 87555(b)(23) requires that "all readily perishable foods or beverages ... shall be stored in covered containers..." 22 CCR Section 87555(b)(28) requires that "all food shall be protected against contamination."

The department has determined the following as it relates to the allegation that staff do not serve residents food of good quality:

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

This facility is hereby cited per 22 CCR Section 87555(a). This facility was previously cited per 22 CCR Section 87555(a) in response to a substantiated complaint on 06/03/2025. As this is a repeat violation, a civil penalty in the amount of $250 is hereby assessed. An exit interview was held with Clark. Appeal rights and a copy of this report were left with staff member Leashia Tyrell-Moore.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
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Control Number 27-AS-20251014094455
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: 10/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2025
Section Cited
CCR
87555(a)
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"The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... 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 conduct a staff training regarding food storage procedures by POC due date.
vincent.moleski@dss.ca.gov
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Based on observation, foods were not stored in a safe or healthful manner, 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: 10/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
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