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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700908
Report Date: 07/17/2025
Date Signed: 07/18/2025 11:50:04 AM

Substantiated


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
05/06/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250506095159
FACILITY NAME:ST. TIMOTHY'S HOMEFACILITY NUMBER:
392700908
ADMINISTRATOR:ALMENDRALA, MARIAFACILITY TYPE:
740
ADDRESS:9230 LARIAT LANETELEPHONE:
(650) 267-3248
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:6CENSUS: 4DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Nicole GolvingTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility failed to disburse funds owed to the deceased's family.
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 07/17/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility caregiver, Nicole Golving, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator to inform her that CCL was present at this time.
It was learned that the facility designated Administrator, Maria Almendrala, was unable to be present at this time so this LPA would have to deliver and present all findings to the present facility staff person, Nicole Golving, at this time.
Current census was 4 residents.
The purpose of this visit was to deliver the findings of this complaint investigation to this facility, and it's representatives, at this time.
Based on a review of the forms and documents retrieved during the course of this investigation, it was learned that R1 had passed away at this facility after having been a resident here for about a year.
It was learned that R1 was R1's own responsible party upon admission to this facility and did not have any
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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 3
Control Number 27-AS-20250506095159
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: ST. TIMOTHY'S HOME
FACILITY NUMBER: 392700908
VISIT DATE: 07/17/2025
NARRATIVE
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additional persons named in R1's admission forms and documents.
It was learned that this facility did not have an alternate person, or entity, to disburse the refund to upon R1's death so one was not given at this time.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

Appeal rights were printed and a copy was left with the facility designated personnel at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250506095159
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: ST. TIMOTHY'S HOME
FACILITY NUMBER: 392700908
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2025
Section Cited
CCR
87507(5)(c)
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A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident's estate, within 15
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The facility designated representative stated that a refund will be given and deposited into the bank account, or estate, of the deceased. A statement of correction, along with proof of refund given, will be completed and submitted into CCL by the due date.
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days after the personal property is removed.
The facility was found to be deficient as evidenced by review of the resident records that upon notice of death to a resident this facility has still not issued a refund for the pre-paid basic services fees which posed a potential threat to the Health, Safety, and Personal Rights of 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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3