342701191-2-17-2026-27-AS-SRIN-DS9PVA-20260317113850

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701191
Report Date: 02/17/2026
Date Signed: 02/17/2026 01:18:26 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
08/25/2025 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250825160003

FACILITY NAME:	CA CARING HANDS		FACILITY NUMBER:	342701191
ADMINISTRATOR:	MICHAEL JANKOWSKI		FACILITY TYPE:	740
ADDRESS:	8797 TWINBERRY WAY		TELEPHONE:	(916) 667-3248
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 5	DATE:	02/17/2026
		UNANNOUNCED	TIME BEGAN:	01:14 PM
MET WITH:	Arianne Dagohoy		TIME COMPLETED:	01:36 PM

ALLEGATION(S):

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Resident sustained multiple injuries due to staff abuse or neglect.

INVESTIGATION FINDINGS:

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On 02/16/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care staff Arianne Dagohoy and explained the purpose of the visit. The purpose of this visit is to deliver complaint finding for the above allegation. Per care staff Dagohoy, Administrator Michael Jankowski is out of the state on vacation on 02/07/2026 and will return at the end of the month. The facility census was five (5) residents with two (2) staff present.

It was alleged that the resident sustained multiple injuries as a result of staff abuse or neglect. During the course of this investigation, it was learned that Resident 1 (R1) had been placed on hospice and was diagnosed with an underlying health condition that causes involuntary, spasm-like movements. These movements frequently caused R1 to thrash, resulting in self-inflicted injuries to their arms, legs, and head, including impacts against the bed, wheelchair, or other surfaces such as a sofa.

CONTINUED LIC 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2026

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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Control Number 27-AS-20250825160003

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: CA CARING HANDS	FACILITY NUMBER: 342701191
	VISIT DATE: 02/17/2026

NARRATIVE

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The facility had received physician orders to use a blanket restraint system while R1 was in bed to prevent them from accidentally falling or flinging themselves off the bed. All staff members interviewed denied ever hitting R1 or any other resident, stating that observed injuries were consistent with R1’s medical condition. In an interview with three out of three residents who all stated they do feel safe living in the home and have no concerns about the allegations. Moreover, hospital staff found no concerns about abuse and documented that R1’s injuries were consistent with their underlying condition. Based on records review, the allegation was unable to corroborate the allegation.

This agency has investigated the complaint alleging It was alleged that the resident sustained multiple injuries as a result of staff abuse or neglect. The department have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2026

LIC9099 (FAS) - (06/04)

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