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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920117
Report Date: 03/26/2026
Date Signed: 03/26/2026 03:07:29 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
03/18/2026 and conducted by Evaluator Sabrina Calzada
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260318114827
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: 5DATE:
03/26/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Bali Rai, Administrator TIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff did not administer resident's medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on March 18, 2026, and met with Administrator, Bali Rai. Also present were staff, Yasmin Bennett and Vetelan "Janet" McCubbin. LPA observed (1) resident in the common area and (4) residents resting in their rooms.

During the investigation, LPA interviewed the Administrator, (1) staff, the Ombudsman, and an individual who is familiar with prior resident (R1). (R1) resided at the facility for a respite stay of (2) weeks, to recover after surgery, and was not availble for an interview. LPA reviewed documentation related to (R1), including the Physician's Report, Hospital discharge paperwork and Medication Administration Record (MAR) for March 2026. The Physician's Report notes that (R1) needs assistance with storage and administration of pain medications and does not have any cognitive loss. The results of the investigation are as follows:

Allegation: Staff did not administer resident's medication. The allegation states that resident (R1) asked for their medications on the night of March 16, 2026, and was told "No" by staff.
*cont on 9099C-1..
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
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-20260318114827
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: 03/26/2026
NARRATIVE
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9099C-1..Staff (S1) stated she was on vacation from March 8, 2026 through March 13, 2026 so did not see (R1) for about half the time they were at the care home, and confirmed (R1) moved out on March 19, 2026.
(S1) stated the Ombudsman came by twice and the second time (R1) requested the case be dropped. (S1) stated that (R1) was fully cognitive and explained (R1) was taking several PRN medications- Oxycodone, Tylenol and Ibuprofen. (S1) stated PRN Oxycodone was to be taken every (6) hours, and (R1) "always asked for Oxycodone" for pain following surgery on their arm. (S1) explained "(R1) was supposed to ask" for all PRN medications and so staff didn't automatically administer it, confirming she would give (R1) their "am" meds when they returned at 10:00 am and and later their dinner meds.

Both the Administrator and (S1) stated (R1) would leave the facility at 6:00 am to go to the clinic and would return anywhere between 10 am- 3 pm, as it varied. The Administrator stated she was here daily from March 7, 2026 through March 13, 2026, which is reflected on the MAR, (R1) would always ask for medication when they were in pain and staff would always administer it to them. The MAR shows that (R1) received Oxycodone on March 8, 2026 (3:00 am). An individual who is familiar with (R1) stated that they felt (R1) was "pretty credible" in what they stated about the PRN medication not being given and confirmed that (R1) stated there was only an issue with medications not being given on 3/16/2026, at bedtime. Physician's orders show there were no scheduled medications to be administered at bedtime.

The MAR for March 2026 reflects that all scheduled medications were given, except when (R1) was out of the facility. In addition, the MAR shows PRN Oxycodone 10mg was administered, at different intervals, starting on March 5, 2026 through March 15, 2026 (5:00 pm) and was not ever administered at 8:00 pm. Tylenol 325mg was administered multiple times from March 5, 2026 through 7, 2026, including one time at 8:00 pm, and once on March 14, 2026. Ibuprofen was administered one time, on March 6, 2026 (5:00 pm). The MAR shows that (R1) missed medications on the morning of March 16, 2026 but received medications at 5:00 pm that day, and the last medications administered were on March 19, 2026 in the morning, prior to (R1) moving out.

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.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2