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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701248
Report Date: 02/10/2026
Date Signed: 02/10/2026 01:32:24 PM

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
01/05/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260105163353
FACILITY NAME:SACRAMENTO SENIOR LIVING IIFACILITY NUMBER:
342701248
ADMINISTRATOR:LEWIS, SALOTEFACILITY TYPE:
740
ADDRESS:34 LOMA MAR CTTELEPHONE:
(530) 710-5707
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 6DATE:
02/10/2026
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Facility Staff: Netani Tuivu TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff did not ensure resident received adequate food service.
Staff prevented resident from attending day program services.
Staff did not dispense medication to resident as prescribed.
Staff did not communicate in a timely manner to coordinate resident’s care.
Staff did not ensure resident received timely medical care.
INVESTIGATION FINDINGS:
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On 2/10/2026 at 12:00 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility staff Netani and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The facility administrator was not present during today's visit. The current census is 6.

Allegation: Staff did not ensure resident received adequate food service.
It was alleged that staff did not ensure resident received adequate food service. This investigation consisted of interviews with residents, and facility observation. On 01/13/2026, LPA Hughes conducted a visit to the facility. LPA spoke with 3 out of 5 residents who stated they have no concern about not being provided with an adequate amount of food in the facility. LPA toured the facility and observed the facilities 2-day and 7-day supply of food with a sufficient supply of food for residents in care. There was not enough evidence present to corroborate this allegation; therefore, the allegation is unsubstantiated.
Continuation 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
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 6
Control Number 27-AS-20260105163353
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: SACRAMENTO SENIOR LIVING II
FACILITY NUMBER: 342701248
VISIT DATE: 02/10/2026
NARRATIVE
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Allegation: Staff prevented resident from attending day program services.

It was alleged that staff prevented a resident from attending day program services. This investigation consisted of interviews with residents, facility staff and the reporting party. On 1/13/2026, LPA Hughes conducted a visit to the facility. LPA spoke with 2 out of 5 residents who stated that they do not attend day program. Additional interview with resident (R1) stated that facility staff allow them to attend day program daily, stating staff assist them with preparing for day program. Interview with the facility administrator reported that the resident (R1) enjoys day program, and facility staff have never prevented the resident from attending day program services. LPA attempted to speak with the reporting party but could not obtain any further details. There was not enough evidence present to corroborate this allegation; therefore the allegation is unsubstantiated.

Allegation: Staff did not dispense medication to resident as prescribed.

It was alleged that staff did not dispense medication to a resident as prescribed. This investigation consisted of interviews with residents, facility staff, and a review of records. On 1/13/2026, LPA Hughes conducted a visit to the facility and spoke with facility staff (S2) who stated that they primarily dispense resident’s medications, stating that residents are given medications timely as prescribed. Interview with 3 out of 5 residents stated that they receive their medications timely as prescribed. Review of the Medication Administration Record (MAR) and Centrally Stored Medication Administration Record (CSMDR) for resident (R1) and (R2) indicated no discrepancies in medications not being administered as prescribed.

Allegation: Staff did not communicate in a timely manner to coordinate resident’s care and Staff did not ensure resident received timely medical care.

It was alleged that staff did not communicate in a timely manner to coordinate resident’s care with physician’s appointments for body rashes. This investigation consisted of interviews with facility staff, residents, the reporting party, and records review. On 1/13/2026 LPA Hughes conducted a visit to the facility and spoke with the facility administrator who reported that the resident has been seen by their primary care physician regarding a body rash initially on 10/2025. The administrator stated that the resident was medically cleared on 10/16/2025. The resident was seen again by their primary care physician on 01/2026 regarding a body rash and cleared on 1/30/2026. Interview with resident R1 stated that they suffer from itching due to rashes on their body. Resident (R1) stated that the facility administrator assists the resident with scheduling and transportation to physician’s appointments.

Continuation 9099-C

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

DATE: 02/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
01/05/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260105163353

FACILITY NAME:SACRAMENTO SENIOR LIVING IIFACILITY NUMBER:
342701248
ADMINISTRATOR:LEWIS, SALOTEFACILITY TYPE:
740
ADDRESS:34 LOMA MAR CTTELEPHONE:
(530) 710-5707
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 6DATE:
02/10/2026
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Facility Staff: Netani Tuivu TIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
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5
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8
9
Staff did not provide adequate supervision to prevent resident from eloping.
INVESTIGATION FINDINGS:
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On 2/10/2026 12:15 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility staff Netani and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The facility administrator was not present during today's visit. The current census is 5.

Allegation: Staff did not provide adequate supervision to prevent resident from eloping.
It was alleged that staff did not provide adequate supervision to prevent resident from eloping. This investigation consisted of interviews with residents, facility staff, reporting party, and records review. On 1/13/2026 LPA spoke with the facility administrator who reported that resident (R1) left the facility unassisted on 12/29/2025, in which the administrator was present at the facility and followed the resident. Interview with resident (R1) stated that they are unable to leave the facility unassisted, stating that they left the facility two-weeks ago and was followed by facility staff.

Continuation 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
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 6
Control Number 27-AS-20260105163353
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: SACRAMENTO SENIOR LIVING II
FACILITY NUMBER: 342701248
VISIT DATE: 02/10/2026
NARRATIVE
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Additional interview with the reporting party reported that resident (R1) left the facility unassisted and was found at a gas station, additional information regarding the incident was not provided as the RP did not provide further details regarding the incident. LPA conducted a review of the LIC 602 Physician's report for resident (R1) it was reported that resident (R1) is unable to leave the facility unassisted. However, staff reported that resident R1 was followed and monitored by facility staff at the time of the elopement.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation 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 violation occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20260105163353
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: SACRAMENTO SENIOR LIVING II
FACILITY NUMBER: 342701248
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
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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: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20260105163353
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: SACRAMENTO SENIOR LIVING II
FACILITY NUMBER: 342701248
VISIT DATE: 02/10/2026
NARRATIVE
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During an additional interview, the reporting party stated that the resident was suspected of having body lice twice, and at their request, resident (R1) was evaluated by a physician and were cleared of any indication of body lice. The reporting party further stated that the resident was observed to have a body rash only, and the facility did send medical clearance for the resident. Review of resident (R1) records indicated the resident was evaluated by a physician and medically cleared for two separate instances. There is not enough evidence present to corroborate this allegation.

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: 02/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6