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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347000702
Report Date: 12/23/2025
Date Signed: 12/23/2025 11:24:41 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
12/10/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251210082509
FACILITY NAME:INDOCARE HOUSE 1FACILITY NUMBER:
347000702
ADMINISTRATOR:LOMENDEHE, PAULFACILITY TYPE:
740
ADDRESS:8278 NEWFIELD CIRCLETELEPHONE:
(916) 682-5461
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 5DATE:
12/23/2025
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Facility Administrator: Paul LomendeheTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not treat resident with respect.
Staff did not ensure resident had enough clothing.
INVESTIGATION FINDINGS:
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On 12/23/2025 at 9:30 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with facility licensee Paul Lomendehe and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 5. A brief interview with conducted with Paul.

Allegation: Staff did not treat resident with respect
It was alleged that staff did not treat resident with respect. This investigation consisted of interviews with residents and facility staff. On 12/15/2025 LPA Hughes conducted a visit to the facility, and spoke with 3 out of 4 residents in care who all stated that they have no concerns about facility staff not treating them with respect. Interview with 2 out of 2 facility staff stated that residents in care are always treated with respect. An additional interview with resident (R1) indicated at facility staff were nice to them, however R1 reported that staff did not answer questions related to their personal relationship with family, which does not indicate that R1 was treated disrespectfully. There is not enough information to corroborate this allegation, therefore the allegation is unsubstantiated.
LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
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 5
Control Number 27-AS-20251210082509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: INDOCARE HOUSE 1
FACILITY NUMBER: 347000702
VISIT DATE: 12/23/2025
NARRATIVE
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Allegation:Staff did not ensure that resident had enough clothing

It was alleged that staff did not ensure resident had enough clothing. This investigation consisted of interviews with facility staff, residents, and records review. Interview with facility staff stated that the facility does not provide clothing for residents in care. However the facility licensee stated that resident (R1) arrived to the facility with very limited clothing supply, and the facility used their own funds to purchase clothing for the resident. Interview with 3 out of 4 residents in care reflected that residents have no concerns about not having adequate clothing, stating that their responsible parties purchase clothing on their behalf. Interview with resident (R1) indicated that the facility only provided used and donated clothing items to the resident. LPA reviewed records for resident (R1) which reflected that the facility Admissions Agreement does not indicate the facilities responsibility to provide clothing to residents in care, or specify an agreement that resident (R1) P&I funds should be used for clothing. Review of R1’s LIC 621 Client/Resident Personal Property and Valuables indicated that the resident arrived at the facility with very limited clothing items. Additional review of the LIC 405 Record of Client's/ Residents Safeguarded Cash Resources in R1’s file did not show that the facility handles cash for the resident. There is not enough information or evidence to corroborate this allegation, therefore the allegation is unsubstantiated.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.



An exit interview was conducted, and a copy of this report was provided to facility at the end of this visit.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
12/10/2025 and conducted by Evaluator Shakaricka Hughes
COMPLAINT CONTROL NUMBER: 27-AS-20251210082509

FACILITY NAME:INDOCARE HOUSE 1FACILITY NUMBER:
347000702
ADMINISTRATOR:LOMENDEHE, PAULFACILITY TYPE:
740
ADDRESS:8278 NEWFIELD CIRCLETELEPHONE:
(916) 682-5461
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 6DATE:
12/23/2025
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Facility Administrator: Teresita LomendeheTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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9
Staff did not ensure resident's dental needs were met.
INVESTIGATION FINDINGS:
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On 12/23/2025 at 9:30 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with facility administrator Teresita Lomendehe and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6. A brief interview with conducted with Teresita.

Allegation: Staff did not ensure residents dental needs were met
It was alleged that staff did not ensure residents dental needs were met. This investigation consisted of interviews with residents and staff. On 12/15/2025 LPA Hughes conducted a visit to the facility and spoke with 3 out of 4 residents in care who all stated that they have no concerns about their dental needs not being met, stating that outside services provided transportation to and from medical appointments as necessary. Interview with 2 out of 2 facility staff reported that residents are taken to dentist appointments whenever needed, staff were unable to give details on how often residents attend dental appointments.

Continuation 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20251210082509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: INDOCARE HOUSE 1
FACILITY NUMBER: 347000702
VISIT DATE: 12/23/2025
NARRATIVE
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Interview with the facility licensee stated that resident (R1) was taken to the dentist upon their arrival to the facility in September 2020. LPA requested to review R1’s dental records but was told that the facility did not have any records on file, and the dental office where R1 received dental treatment was now closed. Interview was resident (R1) revealed that they never received dental care while residing in the facility. This allegation was observed not in compliance with Title 22 regulation Incidental Medical and Dental Care 87465(a)(2). As the facility did not ensure a resident in care dental needs were met.

As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Paul and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.
 
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20251210082509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: INDOCARE HOUSE 1
FACILITY NUMBER: 347000702
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2025
Section Cited
CCR
87465(a)(2)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance... The licensee shall provide assistance in meeting necessary medical and dental needs...
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The licensee agrees to remain in compliance with Title 22 regulation 87465 at all times. The licensee agrees to provide assistance to routine medical and dental appointments for residents in care as needed. The licensee will retain records of routine medical and dental appts for residents in care. The licensee
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This requirement was not met as evidenced by:
The facility did not ensure that a resident in care (R1) was provided with routine dental care as needed.
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agrees to provide LPA Hughes with a statement of acknowledgement and understanding of the regulation by 12/26/2025 via email.
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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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5