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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701489
Report Date: 08/12/2025
Date Signed: 08/22/2025 11:13:38 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
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: 5DATE:
08/12/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Beatrice Clark, LicenseeTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not use the proper equipment to move resident in care resulting in injuries to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/12/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced to close a complaint. LPA Campbell met with Licensee Beatrice Clark and explained the purpose of the visit.

Regarding the allegation staff did not use the proper equipment to move resident in care resulting in injuries to resident, resident reported having a skin tear and reported she had hurt her arm because the bed pinched it, not because of staff. When LPA Campbell asked about the injury, X3 stated two staff had assisted her but she didn’t remember their names. The Hoyer lift was not used and was not required per the residents 602. Instead, X3 reported that staff help her out of bed 2 at a time.

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: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
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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