342701306-10-2-2025-27-AS-SRIN-DMQ2LV-20251022173012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701306
Report Date: 10/02/2025
Date Signed: 10/02/2025 11:54:46 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
01/08/2025 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20250108170719

FACILITY NAME:	MEADOWS SENIOR LIVING, THE		FACILITY NUMBER:	342701306
ADMINISTRATOR:	SELLERS, ALYSSA		FACILITY TYPE:	740
ADDRESS:	9325 EAST STOCKTON BLVD.		TELEPHONE:	(916) 877-7835
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	160	CENSUS: 84	DATE:	10/02/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Alyssa Sellers		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee is retaining a resident that requires a higher level of care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/2/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct a follow up visit and deliver findings regarding the allegation noted above. LPA met with the Administrator/Executive Director, Alyssa Sellers (AD) and stated the purpose of the visit.
The complaint alleged that the licensee was retaining a resident who required a higher level of care than the facility is licensed to provide. The investigation into this allegation consisted of interviews, and record reviews of available documentation.

Through staff interviews, it was explained that residents are assessed prior to admission, then reassessed 30 days after admission, every six months, and when there is a change in condition or hospitalization. The assessments are completed by the Director of Health and Wellness (S1), who is a licensed vocational nurse (LVN) who receives ongoing training from the company’s regional nurse.
{9099-1}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

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-20250108170719

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: MEADOWS SENIOR LIVING, THE	FACILITY NUMBER: 342701306
	VISIT DATE: 10/02/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The assessment tool helps determine whether a resident’s needs can be met by the facility or if a higher level of care, such as a Skilled Nursing Facility (SNF), is required.

Interviews also revealed that S1 evaluates residents' ability to perform activities of daily living (ADLs) and provides recommendations to the Administrator, who then sends the final decision to the corporate team for review and approval. Other staff involved in assessments include the Residential Care Director and the Sales Director.

A review of R1's records shows that assessments were conducted and documented. R1’s initial care assessment, completed on 8/16/22, showed that R1 required staff assistance with grooming, mobility (wheelchair use), showering, queueing with toileting, and medication management due to medical condition (M1). R1 was noted as alert and oriented, able to communicate needs, and independent in many areas of care. The medical assessment from 8/14/22 confirmed that R1 had no mental health conditions and required only minimal assistance with self-care. A later medical assessment, dated 1/16/25, continued to show that R1 did not have a cognitive impairment, remained alert, and required minimal assistance with daily activities. Though R1 was non-ambulatory, they were able to transfer independently and feed themselves. R1 also remained able to manage personal finances and medications.

Progress notes showed that the facility coordinated with outside professionals, including hospital social workers, APS, and the Ombudsman, when R1’s condition changed. In January 2025, the hospital Social Worker informed the facility that R1 would be moved to a Skilled Nursing Facility. The facility, in turn, determined that R1’s condition had changed and that they could no longer meet R1's care needs, thus denying readmission. The facility also took steps by contacting APS and the Ombudsman in assisting R1 find proper placement.

Based on the interviews and reviewed documentation, the preponderance of evidence is not met, therefore, the allegation is UNSUBSTANTIATED. An unsubstantiated finding means that although the allegation may have happened the preponderance of evidence does not prove it.

No deficiencies were cited as a result of this visit. An exit interview was conducted and a copy of this report and appeal rights were provided.

{9099-2}

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2