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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000389
Report Date: 11/04/2025
Date Signed: 11/04/2025 04:26:09 PM

Document Has Been Signed on 11/04/2025 04:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ATRIA EL CAMINO GARDENSFACILITY NUMBER:
347000389
ADMINISTRATOR/
DIRECTOR:		STANSEL, DANAFACILITY TYPE:
740
ADDRESS:2426 GARFIELD AVETELEPHONE:
(916) 488-5722
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 325CENSUS: 228DATE:
11/04/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Dana Stansel, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Executive Director (ED), Dana Stansel, to conduct a case management visit in relation to a separate inspection conducted on today’s date, November 4, 2025.

LPA reviewed resident (R1's) documentation. The facility provided R1's progress notes indicating that R1 was sent to the hospital on January 14, 2025, due to increased confusion and hallucinations. R1 was reassessed by the facility on January 22, 2025, which indicated that R1 required assistance three (3) times per day for orientation "mild/moderate impairment of memory, disorientation, and may display anxiety with memory difficulties. May be perceived as oriented, but memory deficits seen over time. Requires some prompting and encouragement 1 to 3 times per day". R1's previous assessment conducted on March 28, 2024 did not indicate that resident required assistance. R1's Physician's Report LIC602A dated January 6, 2022 indicated that R1 had mild cognitive impairment and did not exhibit confusion/disorientation. R1's Physician's Report LIC602A dated January 21, 2025 indicated that R1 had a primary diagnosis of Dementia and exhibits confusion/disorientation. Interview with ED indicated that R1 required additional care due to progression of Dementia diagnosis. The facility implemented additional care for R1.

According to R1's Identification and Emergency Information LIC601, R1 is their own responsible party for financial affairs, payment for care, and their own legal guardian. R1's LIC601 also included family members to notify in an emergency. Email correspondence indicated that the facility was aware that R1's family member was attempting to gain Durable Power of Attorney (DPOA) in order to assist R1. According to
invoices provided by the facility, R1 was on an automatic payment plan. The automatic payment did not go
************************************************Continued on LIC809-C********************************************
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Angela Hood
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ATRIA EL CAMINO GARDENS
FACILITY NUMBER: 347000389
VISIT DATE: 11/04/2025
NARRATIVE
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through on February 5, 2025 and was returned on February 8, 2025. R1's automatic payments continued to be returned until April 10, 2025. Due to non-payment, the facility began the 30-day eviction process sending notification to R1 via certified mail on April 28, 2025. The facility did not provide LPA a signed certified mail proof of service for this date. An additional 30-day notice to pay or quit was sent to R1 via certified mail on May 7, 2025 and the certified mail received was signed by R1 on May 13, 2025. The facility filed an unlawful detainer complaint with the Superior Court of California County of Sacramento on July 22, 2025. According to Proof of Service of Summons, R1 was personally served a copy of the summons, complaint, civil case cover sheet, and plaintiff's mandatory cover sheet and supplemental allegations unlawful detainer on July 24, 2025. The Proof of Service of Summons indicated that R1 was served at their home as "a competent member of the household (at least 18 years of age) at the dwelling house or usual place of abode of the party. I informed him or her of the general nature of the papers". R1 has a Dementia diagnosis as of the LIC692A dated January 21, 2025 with confusion/disorientation and also had a family member in the process of obtaining DPOA status who was not sent the 30-day notice or unlawful detainer complaint documentation.
Interview with R1 indicated that they do not check their mail frequently and that they have been receiving documents that they do not understand. R1 indicated that they received documents saying they owe something. R1 believed it was for furniture purchased in the 1970s when their spouse was living and expressed they were afraid they could go to jail. R1 indicated that they have not purchased any furniture recently and that their spouse has passed away. Observation of R1 indicated that they were exhibiting confusion. The facility provided LPA with all court documentation pertaining to the unlawful detainer complaint and there were no indication that the court was notified of R1's current primary diagnosis.

R1's progress notes indicated that they were sent to the hospital on September 19, 2025 due to increased confusion and strong urine odor. Progress notes also indicated that on September 21, 2025 R1 was noted to have a urinary tract infection and prescription medication was ordered. Interview with ED indicated that the facility had a meeting regarding over reporting and indicated that this incident was not reported to CCLD. CCLD does not have record of the September 19, 2025 incident. LPA had a conversation with ED regarding reporting requirements and ED agreed that the facility will begin reporting all hospitalization incidents to CCLD.

As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D pages.
Exit interview was conducted. A copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Angela Hood
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/04/2025 04:26 PM - It Cannot Be Edited


Created By: Angela Hood On 11/04/2025 at 02:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ATRIA EL CAMINO GARDENS
FACILITY NUMBER: 347000389

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/18/2025
Section Cited
CCR
87468.1(a)(1)

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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement is not met as evidenced by:
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Facility will submit a plan to ensure that residents' rights are not being violated when they have a change in cognition and provide to LPA by the POC due date of 11/18/25.
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Based on interviews conducted and records reviewed, the facility did not ensure resident (R1) was being treated with dignity when R1 had a change in cognition and facility did not consider change during eviction process, which poses a potential health, safety, and personal rights risk to residents in care.
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Deficiency Dismissed
Type B
11/18/2025
Section Cited
CCR87468.1(a)(3)

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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation..or other actions of a punitive nature...
This requirement is not met as evidenced by:
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Facility will provide a draft of a 30-day eviction notice, that is not a notice to pay or quit, indicating the notice is due to non-payment and remove the intimidating verbiage. Sample notice will be used in future instances of eviction for non-payment.
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Based on records reviewed, the facility provided a 30-day notice to pay or quit indicating that if resident (R1) does not pay by the date and time indicated that R1 is required to move or surrender possession of their apartment, or if payment is not made in full they are no longer allowed to remain in the community, and they must vacate and deliver possession of their apartment, which poses a potential health, safety, and personal rights risk to the residents in care.
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Facility will send a copy to LPA by the POC due date of 11/18/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maribeth Senty
NAME OF LICENSING PROGRAM MANAGER:
Angela Hood
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/04/2025 04:26 PM - It Cannot Be Edited


Created By: Angela Hood On 11/04/2025 at 03:30 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ATRIA EL CAMINO GARDENS
FACILITY NUMBER: 347000389

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/18/2025
Section Cited
CCR
87211(a)(1)(D)

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87211 Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.
This requirement is not met as evidenced by:
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Executive Director indicated that they will ensure all reporting requirements are being followed. Facility will submit a statement of understanding by the POC due date of 11/18/25.
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Based on records reviewed and interviews conducted, the facility did not ensure that they notified CCLD of R1's being sent to the hospital on 9/19/25, which poses a potential health, safety, and personal rights risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maribeth Senty
NAME OF LICENSING PROGRAM MANAGER:
Angela Hood
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2025


LIC809 (FAS) - (06/04)
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