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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345003012
Report Date: 07/29/2025
Date Signed: 07/29/2025 11:54:34 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
05/07/2025 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250507110528
FACILITY NAME:LITTLE BROOK CARE HOME #2FACILITY NUMBER:
345003012
ADMINISTRATOR:POP, PERSIDAFACILITY TYPE:
740
ADDRESS:3840 DELL RDTELEPHONE:
(916) 514-0678
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
07/29/2025
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Persida PopTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee did not follow proper eviction procedures.
INVESTIGATION FINDINGS:
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On July 29, 2025 (7/1/25), Licensing Program Analyst (LPA) Kevin Mknelly spoke to Persida Pop, administrator to deliver complaint findings for the above allegation.

LPA reviewed resident records, facility records and conducted interviews.
LPA finds that the allegations cited above are substantiated.

On 4/27/25, R1 had an episode of verbal aggression, medication refusal and was on the floor from a, possibly intentional attention seeking, “fall”. Family was called by facility staff to attempt to get R1 from the floor and for R1 to take medication. Family called 9-1-1 for medical assessment.
In interview with the Administrator, they stated that staff would not have called 9-1-1. Rather, Administrator stated that they would have followed usual medication refusal and behavioral strategies.
On 4/28/25, Hospital records showed, R1 was to be discharged to the home. Hospital records noted R1 to “return to current ALF (assisted living facility)” but that " current facility refusing to take pt (R1) back due to behaviors." R1 was discharged to another facility's memory care unit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
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 59-AS-20250507110528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LITTLE BROOK CARE HOME #2
FACILITY NUMBER: 345003012
VISIT DATE: 07/29/2025
NARRATIVE
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Facility records and facility staff interviews found that R1 had previously resided in another of the licensee’s homes. While at the other home, R1 at times, exhibited exit seeking, agitation and medication refusals. R1 was transferred to this facility , where behaviors escalated slightly to include property destruction and aggression toward another resident. It was reported that R1 perceived R2 as using R1’s bathroom. In R1’s prior home, R1 had a private bathroom.

A review of R1’s behavioral expressions plan (dated as “completed 5/19/25) found that the plan was not reviewed by an appropriately skilled professional and interviews found that staff did not implement the plan consistently.

Therefore, while the licensee felt that R1 could possibly benefit from a specialty memory care program, the licensee violated R1’s personal right to be protected from involuntary transfer, discharge, or eviction.
The refusal to allow R1’s return resulted in R1 remaining in the hospital longer than their condition required and the hospital used increased medication for behavioral control in the hospital setting.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care.

Report reviewed with . Copy of this report and appeal rights provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 59-AS-20250507110528
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LITTLE BROOK CARE HOME #2
FACILITY NUMBER: 345003012
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/30/2025
Section Cited
CCR
87468.2(a)(20)
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Additional Personal Rights of Residents in Privately Operated Facilities (a) …residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions.
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Licensee will submit a statement of understanding of resident rights as well as eviction procedures by the POC date of 7/30/25.
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 This requirement was not met based on records and interviews. This posed an immediate risk to R1’s personal rightsand welbeing.
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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: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3