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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701489
Report Date: 04/16/2025
Date Signed: 04/16/2025 05:09:49 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
04/14/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250414104810
FACILITY NAME:CASA DORISFACILITY NUMBER:
342701489
ADMINISTRATOR:CLARK, BEATRICEFACILITY TYPE:
740
ADDRESS:8533 LIQUID AMBER WAYTELEPHONE:
(916) 670-0370
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 6DATE:
04/16/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Beatrice Clark, Administrator TIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Residents are not provided activities.
Staff are not assisting residents with soiled diapers in a timely manner.
INVESTIGATION FINDINGS:
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On 04/16/2025, Licensing Program Analyst, Renee Campbell arrived to the facility unannounced regarding a new complaint. LPA Campbell met Administrator Beatrice Clark and explained the purpose of the visit.

Regarding the allegation that staff are not assisting residents with soiled diapers in a timely manner, LPA Campbell interviewed X2 and X3 asked how long it takes for staff to change after a toileting accident. Both X2 and X3 reported that staff assist with accidents within 10 to 15 minutes.

Regarding the allegation that resident are not provided activites, X2 reported they had not been provided outings but also reported they did not wish to leave her room because she was afraid of having accidents.
X2 reported they had little interest in going on outings but staff offer activites for residents in the facility.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED.




Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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 3
Control Number 27-AS-20250414104810
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: CASA DORIS
FACILITY NUMBER: 342701489
VISIT DATE: 04/16/2025
NARRATIVE
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Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given to XXXXXXX.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3