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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920117
Report Date: 10/14/2025
Date Signed: 10/14/2025 11:21:48 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
09/24/2025 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250924094337
FACILITY NAME:RAI ANGELSFACILITY NUMBER:
345920117
ADMINISTRATOR:RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:6613 TRILBY CT.TELEPHONE:
(916) 735-5610
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 6DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Bali Rai, Administrator TIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff did not allow resident to use the phone.
Staff did not follow physician's orders.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver investigative findings to a complaint received on September 24, 2025 and met with staff Yasmin Bennett and Nidda Taufetee. The administrator, Balwinder Rai, arrived around 10:40 am.

During the investigation, LPA interviewed the Administrator, (4) residents, and a family member of resident (R1). LPA was not able to interview the only staff who was familiar with resident (R1) as they were not currently working at the facility. LPA was also unable to obtain additional specific information from prior resident (R1). LPA reviewed (R1's) care plan, physician’s report and medication list. The results of the investigation are as follows:

(R1) moved in on November 6, 2024 and moved to a related facility nearby on November 13, 2024. Resident was sent out to the Emergency Room on December 3, 2024, from the related facility, and did not return to either care home. ** cont on 9099C-1**

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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 4
Control Number 59-AS-20250924094337
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: 10/14/2025
NARRATIVE
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9099C-1.. Resident (R1’s) Physician’s Report notes a primary diagnosis of Urinary Retention and a foley catheter is needed to assist. (R1) also needs assistance with transfers and dressing/grooming and is able to communicate and follow directions but is not able to leave the facility unassisted.

Allegation: Staff did not allow resident to use the phone. The allegation state staff did not allow resident (R1) to use the phone to call out.


The administrator stated that (R1) "was using the land line a lot" and they did not have a personal cell phone and asserted "other family members complained of the phone being busy and it not being answered", and it was due to (R1) being on the phone so much. The administrator added that during the day, (R1) was on the phone 1.5 hours sometimes and she "told (R1) they cannot be on the phone that long". The administrator stated (R1) was calling Canada and she told them "don't make too many out of state calls".

The administrator confirmed the facility phone is a cordless land line, and (R1) would take the call to their room and was unsure if (R1) was making outgoing or receiving incoming calls.

Four (4) residents stated they each use their personal cell phone and do not use the facility land line.

(R1s) family member stated he is "not aware" of (R1) not being able to make outgoing calls and stated he called (R1) "numerous times and I was always able to talk to (R1)".



Based on information obtained, LPA finds this 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.

Allegation: Staff did not follow physician’s orders. The allegation states staff would not give (R1) their psych meds or the Flomax for urinary retention; staff stole (R1’s) catheter kits to empty their urine, claiming the kits were for someone else at the facility.

The administrator indicated (R1) did not have a catheter, but said they needed one due to having urinary retention. The administrator indicated she is not sure if (R1) moved in with a catheter as they "were using the commode".

*cont on 9099C-2..

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

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20250924094337
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: 10/14/2025
NARRATIVE
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9099C-2.. The administrator confirmed that (R1) "had a catheter kit" and "it did not disappear as no one else used a catheter". The administrator was unsure who gave the catheter kit to (R1). The administrator confirmed (R1) was administered medications as ordered and the facility uses a MAR, commenting that (R1) wanted to keep the meds in their room, but she told them they have to be centrally stored.

Four (4) residents were asked if the facility administers medications as ordered. One resident said they don’t take any medications, two residents stated staff gives them medications, and a third resident was unsure if staff give them medication due to having a diagnosis of Dementia.

(R1s) family member stated "no, not that I'm aware of" when asked if the facility was not giving medications.



Hospital documentation shows (R1) went to the ER on 11/11/2024 and was given a diagnosis of Urinary Retention and was requested to schedule an appointment within (3) days with their primary care provider. (R1) moved to a related to a related facility on 11/15/2024.

Electronic documentation show that all medications were administered as prescribed from 11/6/24 through 11/13/24. There is no note about (R1) having a catheter on the documentation.


Based on information obtained, LPA finds this 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.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
09/24/2025 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250924094337

FACILITY NAME:RAI ANGELSFACILITY NUMBER:
345920117
ADMINISTRATOR:RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:6613 TRILBY CT.TELEPHONE:
(916) 735-5610
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 6DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Bali Rai, Administrator TIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff slapped resident.
INVESTIGATION FINDINGS:
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During the investigation, LPA interviewed the Administrator, (4) residents, and a family member of resident (R1). LPA was not able to interview the only staff who was familiar with resident (R1) as they were on leave from working at the facility. The results are as follows:

Allegation: Staff slapped resident. The allegation states staff slapped (R1) for turning on the light.

The administrator stated she and staff "never slapped (R1) for turning the light on". Four (4) residents
were interviewed. Two (2) residents stated no staff has ever slapped them and they have never observed any bruising on any other residents; a second resident was not able to provide any information; a third resident indicated they were "never slapped here" and "doesn't really know" if anyone else has been. (R1s) family member stated they are not aware of this happening and never witnessed any abuse at the care home.
Based on information obtained, LPA finds this 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.


Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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 4