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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920019
Report Date: 08/05/2025
Date Signed: 08/05/2025 01:28:56 PM

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
12/23/2024 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20241223132536
FACILITY NAME:ARJAN CARE HOMEFACILITY NUMBER:
345920019
ADMINISTRATOR:BHANDAL, SARVEJEETFACILITY TYPE:
740
ADDRESS:9320 PALMERSON DRIVETELEPHONE:
(916) 494-1481
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:6CENSUS: 6DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sarvejeet BhandalTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Facility staff are not assisting resident with grooming as needed
INVESTIGATION FINDINGS:
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On 08/05/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 12/23/2024. LPA met with Administrator Sarvejeet Bhandal and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and record review.

Please continue to LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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 5
Control Number 59-AS-20241223132536
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: ARJAN CARE HOME
FACILITY NUMBER: 345920019
VISIT DATE: 08/05/2025
NARRATIVE
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Allegation: Facility staff are not assisting resident with grooming as needed

Based on interviews with staff indicated that they did not assist R1 in cutting their finger and toe nails due to R1 having diabetes. Staff further stated they did not arrange for R1’s nails to be trimmed which resulted in R1’s finger and toe nails to become long and unkept.

Based on LPAs interviews, the facility did not ensure that R1s grooming needs were met. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D.

As a result of today's visit deficiencies are cited.

Exit interview conducted a copy of the report and appeal rights were left at the facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20241223132536
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: ARJAN CARE HOME
FACILITY NUMBER: 345920019
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2025
Section Cited
CCR
87465(a)(1)
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87465Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(1)The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
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Licensee is to submit a plan on how the facility will arrange or assist in arranging residents medical needs. The plan shall include procedures, staff responsibilities and training.
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This requirement is not met as evidenced by:
Based on interview the licensee did not comply with the section cited above facility did not ensure that R1s nails were trimmed. This poses a potential health and safety risk to residents in care.
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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: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
12/23/2024 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20241223132536

FACILITY NAME:ARJAN CARE HOMEFACILITY NUMBER:
345920019
ADMINISTRATOR:BHANDAL, SARVEJEETFACILITY TYPE:
740
ADDRESS:9320 PALMERSON DRIVETELEPHONE:
(916) 494-1481
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:6CENSUS: 6DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sarvejeet BhandalTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Facility staff are not assisting resident with diabetic care as needed
Facility staff are not assisting resident with incontinence care as needed
Facility staff are not assisting resident with hygiene as needed
INVESTIGATION FINDINGS:
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On 08/05/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 12/23/2024. LPA met with Administrator Sarvejeet Bhandal and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and record review.

Please continue to LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20241223132536
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: ARJAN CARE HOME
FACILITY NUMBER: 345920019
VISIT DATE: 08/05/2025
NARRATIVE
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Allegation: Facility staff are not assisting resident with diabetic care as needed-Unsubstantiated

Based on R1’s Physician Report (LIC602) and staff interviews, R1 is able to do their own injections for their diabetic mediation. The department was unable to interview resident as they moved out of the facility at the time this complaint was received by the department.

Allegation: Facility staff are not assisting resident with incontinence care as needed- Unsubstantiated

The Department conducted interviews and record reviews. R1s Physician Report (LIC602) dated 11/27/2024 indicated R1 was able to care of their own toileting needs. Interviews with staff indicated R1s health started to decline resulting in R1 not wanting to walk and/or care for their own toileting needs. Staff stated they assist R1 with their incontinence needs however due to R1’s decline, it would take several attempts to assist R1.

Allegation: Facility staff are not assisting resident with hygiene as needed-Unsubstantiated

Based on records reviewed, R1 was able to handle their own hygiene needs. Staff interviews indicated they did assist R1 with showers two (2) times a week. The department was unable to interview resident as they moved out of the facility at the time this complaint was received by the department.

Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.



At this time no deficiencies are cited.

Exit interview conducted a copy of the report was left at the facility
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5