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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920117
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:44:02 PM

Unfounded


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
12/18/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20241218155404
FACILITY NAME:RAI ANGELSFACILITY NUMBER:
345920117
ADMINISTRATOR:RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:6613 TRILBY CT.TELEPHONE:
(916) 945-2122
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
03/11/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Balwinder Rai, Administrator TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility is in disrepair.
Facility is unsanitary.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada and Associate Governmental Program Analyst, Vanne Le,
arrived unannounced to complete a complaint investigation and met with caregivers, Veron Reid and Trineesha Buckley, and stated the reason for today's inspection. The Administrator was contacted and arrived around 2:00 pm. (2) residents were observed to be resting in the common areas at the start of the inspection and (3) residents to be resting in their rooms.

During the investigation, LPA interviewed the Administrator, (1) staff, resident (R1) and (2) other residents. LPA reviewed documentation related to (R1) including, but not limited to, hospital discharge papers and incident report (from 12/14/24), physician’s report and medication records.

The results of the investigation are as follows:
Resident (R1) moved to the facility on/around December 7, 2024 and moved out on/around December 19, 2024 as part of a two-week stay only.
*cont on 9099C-1..
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
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 6
Control Number 59-AS-20241218155404
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: RAI ANGELS
FACILITY NUMBER: 345920117
VISIT DATE: 03/11/2025
NARRATIVE
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9099C-1. Allegation: Facility is in disrepair. Allegation states the hallway toilet, which is the only one available for (R1's) use, frequently backs up and contains feces.

Resident (R1) stated the toilet is not working well and regularly overflows in their room, and they are only allowed to use the toilet in their room. On December 19, 2024, the toilet was checked by the Ombudsman and found to be flushing correctly.

On December 19, 2024, the Administrator confirmed there are (3.5) baths, in resident rooms and showed LPA (2) photos of the toilet in (R1's) room that "overflowed one time" and explained that her maintenance staff "found wipes and (1) sock in the toilet 4-5 days ago". On March 11, 2025, the Administrator stated that a washcloth was found also stuck in the toilet on December 20, 2024.

On March 11, 2025, staff (S1) stated that there were issues with (R1's) toilet overflowing a little bit, due to frequent usage and using a lot of toilet paper, and it overflowed one time where there was more water on the floor. (S1) added that (R1) told her in December 2024 that they think their sock was flushed and staff did later find a sock when the toilet was plunged. (S1) stated she is not sure if (R1) did this purposefully, or if it was due to them not being able to see well, and (R1) was advised to stop flushing continuously to prevent any overflow.

On March 11, 2025, (4) toilets were checked for flushing correctly and were found to be working. LPA previously inspected the facility in May 2024 and in September 2024 and all toilets were found to be working correctly. On March 11, 2025, LPA interviewed (2) residents. Both residents stated that there have not been any issues with toilets not flushing correctly.

Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegation: Facility is unsanitary. Allegation states it can take several days for the facility staff to clean the bathroom, raising concerns about hygiene and safety.

On December 19, 2024, the Administrator stated that (R1) went "BM on the floor on purpose". Staff (S1) stated that (R1) would usually make a lot of mess on the toilet and floor due to frequent diarrhea.

*cont on 9099C-2..

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
12/18/2024 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20241218155404

FACILITY NAME:RAI ANGELSFACILITY NUMBER:
345920117
ADMINISTRATOR:RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:6613 TRILBY CT.TELEPHONE:
(916) 945-2122
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 5DATE:
03/11/2025
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Balwinder Rai, Administrator TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility staff delayed emergency services for resident in care.
INVESTIGATION FINDINGS:
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During the investigation, LPA interviewed the Administrator, (1) staff, resident (R1) and (2) other residents. LPA reviewed documentation related to (R1) including, but not limited to, hospital discharge papers and incident report (from 12/14/24), physician’s report and medication records.

The results of the investigation are as follows:

Allegation: Allegation states that when resident (R1) experienced stomach pain and requested to be sent to the hospital, facility staff consulted the administrator and asked (R1) to wait before eventually calling 911.

Resident (R1) stated on December 19, 2024 that he had "stomach pain" 2-3 days ago, on a Monday night, around midnight to 1:00 am, and that he requested to be sent out to the emergency room, but the female staff said she would have to call the Administrator first.
*cont on 9099A-C-1..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 59-AS-20241218155404
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: RAI ANGELS
FACILITY NUMBER: 345920117
VISIT DATE: 03/11/2025
NARRATIVE
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9099A-C-1... Staff (S1) stated on March 11, 2025 that she was the only staff on shift on December 14, 2024 when (R1) asked to go to the hospital. (S1) stated that (R1) had diarrhea, but it was different in that (R1) stated they needed to go to the hospital because their "stool is black" and they had stomach pain. (S1) stated she offered to clean (R1) up but they refused to be cleaned up as they wanted the hospital to do that. (S1) stated that she observed (R1) to be bent over in pain on the couch after they said they wanted to go to the hospital. (S1) stated she called 9-1-1 first from the house phone to tell them what was happening with (R1) and followed the directions they gave her, including to wait on the phone until the ambulance arrived.
(S1) stated she told (R1) she would also be notifying the Administrator and then called the Administrator on he personal cell phone, after calling and being placed on hold with 9-1-1.

(S1) confirmed that (R1) was sent out around 11:30 pm on December 14, 2024 and returned around 4:30 am on December 15, 2024 with one of two medications just prescribed. (S1) confirmed that (R1) had the second medication filled shortly after arriving back to the care home. The (2) new meds were prescribed for (3) days each- Loperamide 2mg-take 1 tablet every 4 hours, as needed for loose stool, and Ondansetron 4 mg prescribed -1 tablet every 4 hours as needed for nausea.

The incident report submitted to the Department states that (R1) notified the caregiver of having episodes of diarrhea, they soiled their clothes and the toilet, and requested the caregiver call 9-1-1. The report states that the caregiver promptly contacted 9-1-1, at 11:10 pm, and the fire engine arrived at 11:18 pm. The report further states that (R1) was tested at the hospital, results were good, and they returned at 5:14 am on December 15, 2024. The discharge papers confirmed that (R1) did have diarrhea for "one day" had a discharge diagnosis of: Vomiting and diarrhea.

The Internal Medicine Discharge Summary- (dated 12/6/24), the day before (R1) moved in, notes that (R1) is a patient with high insulin requirements (discharged with oral medications only given their poor vision/near blindness), and there was a referral placed to GI for chronic diarrhea with possible pancreatic insufficiency.

The Administrator stated she instructs staff to always call 9-1-1 first before calling her and she arrives at the facility when 9-1-1 gets hers.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. *cont on 9099A-2.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 59-AS-20241218155404
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: RAI ANGELS
FACILITY NUMBER: 345920117
VISIT DATE: 03/11/2025
NARRATIVE
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9099C-2... During the investigation, another issue was mentioned to LPA and Ombudsman. Resident (R1) also stated that they are diabetic and staff is "trying to get blood" from him to check his blood sugar, but they are not trained. (R1) stated staff did not test his blood as it's ordered- 3x/day and (R1) "started to refuse". (R1) stated there are (3) staff and one staff is new.

The Administrator stated on December 19, 2024 that "staff do not check blood sugar" and (R1) "can't see well" and explained that staff would "set up the test" and (R1) "pokes their finger with the needle" and staff can assist with the test at that point. The Administrator confirmed that (R1) is not on insulin and takes oral tablets. The Administrator stated an on-call Registered Nurse instructed (R1) how to prick their finger and (R1) acknowledged that he understood and was able to demonstrate that they could.

Per (R1's) physician's report, (R1) is "not able to perform their own glucose testing (ordered 3x/day) and monitoring and is nearly blind.

On March 11, 2025, staff (S1) stated that she did assist (R1) with blood sugar testing but (R1) would refuse to prick themselves on occasion. (S1) stated (R1) asked for guidance, due to not being able to see well, and was able to prick their finger by bringing their finger closer to see. (S1) confirmed she didn't assist (R1) or any other resident with pricking their finger and told (R1) that and she has had training on diabetic care.



The Administrator provided detailed information showing when (R1’s) blood sugar was checked each day, commenting "(R1's) blood sugar was in the high hundreds every time". The documentation shows the facility followed the 3x/day order and documented when (R1) refused in the morning on 12/9/24, 12/15/24, 12/16/24, at lunch on 12/18/24, and at breakfast, lunch and dinner on 12/12/24.

Based on information obtained, LPA finds this concern to be UNSUBSTANTIATED -meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

Exit interview. Copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 59-AS-20241218155404
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: RAI ANGELS
FACILITY NUMBER: 345920117
VISIT DATE: 03/11/2025
NARRATIVE
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9099C-2.. (S1) stated that the toilet did overflow one time where the water ran on the floor, usually a result of (R1) flushing a lot. (S1) stated she asked (R1) to stop flushing continuously to prevent an overflow. (S1) stated she checks each bathroom in the morning when she checks on the residents. (S1) explained that there were (2) staff here the time the toilet overflowed more onto the floor. (S1) stated they sprayed the floor with chemicals and water to clean the floor and will clean throughout the home, as needed, every day.

(2) residents were interviewed and both stated that staff are "always cleaning, including dusting, mopping" and the facility is always clean.

LPA observed the facility floors, bathrooms, resident rooms and common areas to be clean on March 11, 2025, on December 19, 2024 and in May 2024 and September 2024 when inspections were also done.

Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview. Copy of report provided to Administrator.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6