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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920120
Report Date: 10/15/2025
Date Signed: 10/15/2025 02:31:36 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
09/24/2025 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250924093636
FACILITY NAME:HARJIT AND NAVGEET RCFEFACILITY NUMBER:
345920120
ADMINISTRATOR:KAUR, NAVGEETFACILITY TYPE:
740
ADDRESS:5324 NYODA WAYTELEPHONE:
(916) 333-3037
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Navgeet KaurTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not following the admission agreement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Wednesday October 15, 2025, to deliver findings for a complaint regarding the above allegation. LPA met with Administrator Navgeet and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed staff regarding the allegation. LPA reviewed the Assisted Living Waiver Provider handbook, R1’s LIC602 and care plan. LPA learned that R1 is on the Assisted Living Waiver program. As part of R1’s activities of daily living, they require assistance with incontinence care. While the incontinence products are provided through R1’s insurance, the facility provides gloves and wipes. Previously, the Administrator picked up R1’s medications from the pharmacy and asked for reimbursement for R1’s copay. R1 has a payee which handles all of R1's finances.
Based on information obtained during the investigation, LPA finds the allegation to be 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 evidence to prove that the alleged violation occurred. Exit interview. A copy of this report was emailed to the Administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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