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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005043
Report Date: 01/17/2025
Date Signed: 01/17/2025 01:31:27 PM

Unfounded


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
01/16/2025 and conducted by Evaluator Victoria Brown
COMPLAINT CONTROL NUMBER: 27-AS-20250116091342
FACILITY NAME:ELITE ELDERLY CARE HOMEFACILITY NUMBER:
347005043
ADMINISTRATOR:CALAGUI, LANIFACILITY TYPE:
740
ADDRESS:8510 STONEFLOWER WAYTELEPHONE:
(916) 896-5185
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 4DATE:
01/17/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lani CalaguiTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff serve expired food to residents
Staff are not reporting incidents to authorized representatives
Staff are verbally abusive to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegations on 1/17/25 at 8:30am. LPA met with Administrator Lani Calagui and stated the purpose of the visit.

Upon arrival LPA observed residents having breakfast which consisted of cantaloupe, french toast, eggs, bananas, with either preferred coffee, water, or tea.
Regarding allegation, Staff serve expired food to residents, an interview conducted today with Resident #1 (R1-R4) and Responsible parties (RP1 - RP4) revealed that the food is good and there was no knowledge of any expired food being served. An interview with Administrator revealed that there are no expired foods in the home ever. Staff #1 (S1) stated if the food looks like its not right it is not given to the residents. LPA conducted a review of all foods in the refigerator and pantry which revealed foods in the home are deemed to be of good quality and quantity.
Unfounded
Estimated Days of Completion: 30
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
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 27-AS-20250116091342
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: ELITE ELDERLY CARE HOME
FACILITY NUMBER: 347005043
VISIT DATE: 01/17/2025
NARRATIVE
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Regarding allegation, "Staff are not reporting incidents to authorized representatives", an interview conducted today with Resident #1 (R1-R4) and Responsible parties (RP1 - RP4) revealed that they are confident that staff would report any incident should they occur. An interview with Administrator revealed that when residents have an incident the families are notified. Staff #1 (S1) stated Administrator handles the incident reports.

Regarding allegation, "Staff are verbally abusive to residents", an interview conducted today with Resident #1 (R1-R4) and Responsible parties (RP1 - RP4) revealed that none of the staff are verbally abusing the residents. An interview with Administrator revealed that there has not been an incident to report. Staff #1 (S1) stated "I am unaware of this occurring.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given.

"This agency has investigated the complaint alleging the above mentioned allegations. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis."
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2