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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701192
Report Date: 08/14/2025
Date Signed: 08/14/2025 11:54:54 AM

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
05/30/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250530153105
FACILITY NAME:VITA BELLA ELDERLY CARE IIIFACILITY NUMBER:
342701192
ADMINISTRATOR:CLEOPATRA GARDINERFACILITY TYPE:
740
ADDRESS:6700 SUN RIVER DRTELEPHONE:
(916) 490-0237
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:14CENSUS: 13DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Faciltiy Staff: Nina TuilomaTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Staff hit a resident while in care
Staff did not prevent resident from harming another resident in care
INVESTIGATION FINDINGS:
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On 08/11/2025 at 11:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility staff Nina Tuiloma and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. The current census is 13. A brief interview conducted with Nina.

Allegation: Staff hit a resident while in care
It was alleged that facility staff hit a resident while in care. This investigation consisted of interviews with residents and facility staff. On 6/3/2025 LPA Gould conducted a visit to the facility. LPA interviewed 3 out of 5 residents in care, who all stated they have no concerns with staff hitting residents in care. Interviews with 2 out of 3 facility staff reflected that staff have not hit nor witnessed other care staff hit residents in care. An interview with facility staff (S3) reflected that they have never hit a resident in care. An interview conducted with Resident (R1) revealed that the resident could not recall the information needed to corroborate the allegation. Therefore, there was not enough information to corroborate the allegation.
Continuation 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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-20250530153105
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: VITA BELLA ELDERLY CARE III
FACILITY NUMBER: 342701192
VISIT DATE: 08/14/2025
NARRATIVE
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Allegation: Staff did not prevent resident from harming another resident in care

It was alleged that facility staff did not prevent a resident from harming another resident in care. This investigation consisted of interviews with staff and residents, and records review. On 6/3/2025 LPA Gould conducted a visit to the facility. LPA interviewed 3 out of 5 residents, all residents interviewed reported having no concern regarding conflicts between residents. On 8/3/2025 LPA Hughes conducted a follow-up visit to the facility interview with 3 out 3 facility staff revealed that staff had no concerns about residents in care harming other residents. During an interview with Resident (R1) they were unable to recall details relevant to corroborating the information. A review of records, Special Incident Reports (SIR) from 5/22- 5/29/2025 sent to CCLD, indicated that staff intervened promptly between conflicts involving R1 and other residents in care, and redirected residents involved preventing further escalation of conflict. There was not enough evidence to support the allegation, therefore the above allegation could not be corroborated at this time.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED 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.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
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