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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 01:44:42 PM

Unsubstantiated


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
02/13/2025 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20250213143824
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:
01:55 PM
ALLEGATION(S):
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Facility staff caused injuries to resident in care
Facility staff did not report injuries to resident's responsible person
Facility staff did not seek medical attention for resident
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 02/13/2025. 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: 1 of 2
Control Number 59-AS-20250213143824
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 caused injuries to resident in care-Unsubstantiated
According to medical records, Resident #1 (R1) sustained a fracture on their finger on their right hand. R1 was bedbound and required a high level of care. Multiple staff were interviewed and stated the injury was present when R1 was admitted to the facility in November of 2024. Administrator observed additional swelling and reported the injury to R1’s Hospice Nurse. Additionally, there was allegations that R1 was found with bruising on their back area. Based on interviews conducted, there was insufficient evidence to determine if R1 had bruising on their back and if any bruising occurred at the facility.

R1 stated a male “beat” them. R1 did not identify anyone by name. During the investigation, it was found that there were no male residents residing at facility however, there was a male staff. The male staff was interviewed and denied the allegations of abusing R1 or providing care to them at any time. Multiple staff were interviewed and denied seeing anyone aggressive or inappropriate towards R1.

Allegation: Facility staff did not report injuries to resident's responsible person- Unsubstantiated

Based on interviews R1 had the injury before they moved into the facility in November of 2024. Facility staff stated that R1s responsible person knew about the swelling as well. Staff does not have documentation of the conservation. LPA cannot prove or disprove if communication was happening between the facility and R1s responsible person.  

Allegation: Facility staff did not seek medical attention for resident- Unsubstantiated

Staff stated they reported to R1’s Hospice Agency when they observed swelling on R1’s finger. Hospice records documented the injury was reported and additional emergency medical attention was not necessary due to R1 receiving hospice care services.

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: 2 of 2