<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920073
Report Date: 02/20/2025
Date Signed: 02/20/2025 09:14:02 AM

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
07/29/2024 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20240729164839
FACILITY NAME:WHOLESOME ELDERLY ON MAR VISTAFACILITY NUMBER:
345920073
ADMINISTRATOR:FAAMAUSILI, CHRISFACILITY TYPE:
740
ADDRESS:7401 MAR VISTA WAYTELEPHONE:
(916) 678-0268
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 4DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Sylvia PoindexterTIME COMPLETED:
09:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident is receiving prescribed medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/20/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver final findings for a complaint Community Care Licensing (CCL) received on 07/29/24. LPA met with Staff Sylvia Poindexter and explained the purpose of the visit. Staff called Administraor Juan Ramirez, who was unable to make it to the facility but gave staff permisson to sign the report.

During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation.



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

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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-20240729164839
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: WHOLESOME ELDERLY ON MAR VISTA
FACILITY NUMBER: 345920073
VISIT DATE: 02/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff did not ensure resident is receiving prescribed medication. 
Interviews with facility Administrator revealed that Resident #1 (R1) was only at the facility for a couple of days. R1 moved into the facility from a room and board. Staff had picked R1 up from the room and board. When staff picked up R1, R1 did not have their medications. Per R1s Physician's Report (LIC602), they are able to manage their own medications. During this transition, facility was actively working to obtain a current medication list and medication for R1.  

On July 25th, 2024, Administrator Juan Ramirez had reached out to R1s social worker inquiring about R1s medication orders since they had yet to receive them. Facility Administrator did not receive a response. Facility did send R1 to the hospital due to not having their medication and was not at their baseline. R1 did not return to the facility after being hospitalized and was transitioned into skilled nursing.  

Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. 
 
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: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2