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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 01/16/2025
Date Signed: 01/16/2025 02:29:39 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
10/14/2024 and conducted by Evaluator Holly Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241014150651
FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:CRUZ, ALFREDOFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 86DATE:
01/16/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Charles WhiteTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Comfortable temperature is not maintained at the facility as required
Facility staff are unable to assist resident in moving out of bed due to lack of staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Holly Williams made an unannounced visit to conclude the investigation of the above allegations and to deliver the findings. LPAs Williams met with facility administrator Charles White and together discussed the investigation details.
This investigation consisted of interviews, observations, and record review. LPA Williams interviewed White, staff six members (S1-S6) and nine residents (R1-R9).
In an interview, S2 states that they try to get the residents who have Hoyer lifts, up for at least one meal a day. In an intIn an interview, R6 states that the staff members get R6 in and out of bed with the Hoyer Lift just fine. R6 said she has no issues. In an interview, R5 said R5 needs a Hoyer Lift to get out of bed. R5 states he gets his showers on time, and he gets out of bed when R5 needs to.
In an interview, R2 said the temperature is good and the place is clean. In an interview, R3 stated that the temperature is good. In an interview, R4 said the temperature is good.
Based on interviews and observation, the above allegation is UNSUBSTANTIATED, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies were cited regarding the above allegation. An exit interview was held and a copy of this report was left with White

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

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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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