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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920137
Report Date: 08/13/2025
Date Signed: 08/13/2025 12:50:33 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
11/18/2024 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20241118114356
FACILITY NAME:SPLENDOR OF CARMICHAEL AT KEANE, LLC, THEFACILITY NUMBER:
345920137
ADMINISTRATOR:VO, LUIGIFACILITY TYPE:
740
ADDRESS:4921 KEANE DRTELEPHONE:
(916) 550-2908
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria Williams, AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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-Staff are not providing care and supervision
-Staff are not providing assistance with ADLs
-Staff did not seek timely medical
-Staff are not providing medications as prescribed
-Staff are handling residents in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Maria Williams, to deliver complaint investigation findings regarding the above allegations.

During the course of the investigation, LPA conducted a medication count, interviews, and obtained documentation pertinent to the investigation.

Interviews with staff (S1, S2, S3, and S4) indicated that staff are providing good care to residents and are assisting with all activities of daily living (ADLs), including supervision of the residents. Interviews with residents (R2 and R3) indicated that all their needs are being met by facility staff and that they are receiving assistance with ADLs. R2 and R3 indicated that they are receiving good care at the facility. R2 indicated that they have a buzzer they can utilize next to the bed to let staff know they need assistance. Interview with the home health nurse indicated that they had no concerns regarding the facility not providing care and supervision to residents, as well as assistance with ADLs.
************************************************Continued on LIC9099-C*************************************************
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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-20241118114356
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: SPLENDOR OF CARMICHAEL AT KEANE, LLC, THE
FACILITY NUMBER: 345920137
VISIT DATE: 08/13/2025
NARRATIVE
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According to medical records, resident (R1) was sent out to the hospital on October 8, 2024, October 29, 2024, and November 23, 2024. Upon review of medical records, there was no indication that the facility did not seek timely medical attention for R1. Interviews with S2, home health nurse, administrator, and licensee indicated that, when R1 fell out of their bed on October 8, 2025, they were sent to the hospital. Home health records indicated that R1 was sent to the Emergency Room on October 8, 2024. Interview with S1 indicated that staff seek timely medical attention for residents by contacting emergency medical services or hospice services. Interviews with the home health nurse and administrator indicated that R1 was having constipation issues due to pain medication. Home health nurse indicated that R1 was receiving suppositories for constipation that were not working. Home health nurse and administrator indicated that R1 was sent to the hospital and prescribed a stool softener due to suppositories not working. Home health nurse and administrator indicated that a bowel movement (BM) chart was kept for R1. Facility provided R1’s BM chart for November 2024, which did not indicate any missed BM.

On January 24, 2025, LPA conducted a medication count for residents (R4, R5, and R6), comparing the residents’ medication lists on file with medication centrally stored for the residents. LPA did not observe any medication errors. Interviews with R2 and R3 indicated that they receive all their medications as prescribed. Interviews with S1, S2, S3, and S4 indicated that all residents are receiving their medications as prescribed. Interview with the home health nurse indicated that they had no concern regarding the facility providing medications to residents as ordered.

Interviews with S1, S2, S3, and S4 indicated that they have never witnessed staff handling residents in a rough manner. Interviews with R2 and R3 indicated that staff have never handled them too roughly and they have never witnessed staff handling other residents in a rough manner.

Based on medication count, interviews conducted, and documentation obtained, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited.
Exit interview conducted. A copy of the report was provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2