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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701619
Report Date: 02/03/2026
Date Signed: 02/05/2026 08:36:10 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
01/29/2026 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20260129165908
FACILITY NAME:AMERICAN SIKH CARE FACILITYFACILITY NUMBER:
392701619
ADMINISTRATOR:SOHI, JASVIR SINGHFACILITY TYPE:
740
ADDRESS:1975 ERICKSON CIRCLETELEPHONE:
(209) 808-3716
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 4DATE:
02/03/2026
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Jasvir sohiTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff are not providing adequate care to residents while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility on 2/3/2025 at 1:45pm to conduct a complaint investigation. LPA met with administrator Jasvir Sohi and explained the purpose of the visit.

A record review of the staff files indicate that there are 2 backround checks for those residing in the facility over the age of 18 (4 adults working and or residing in the facility). Per the administrator interview, the new employee started without a backround check some 10 days ago, and her husband and thirteen year old offspring sleep in the facility over the weekend. LPA gave guidance to get the staff and her husband backround checked immediately, and they cannot work, reside, or volenteer until its finished. Administrator provided that as part of the CNA training, they have fingerprints on file with the CNA training and the husband security licence. LPA read the regulation for ccl 80012(e)(2,3,4). 916-263-4700 Office should recive the request for transfer with the california drivers license and livescan in the morning sent to, cclascpsacramentosouthro@dss.ca.gov and noel.wolfpetersen@dss.ca.gov
Continued on c page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
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-20260129165908
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: AMERICAN SIKH CARE FACILITY
FACILITY NUMBER: 392701619
VISIT DATE: 02/03/2026
NARRATIVE
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LPA interviewed 1 clients and 2 staff. 1 client has visitors at the time of the LPA's visit, another 2 clients were taking naps.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, is being cited on the attached LIC 9099D.

Citation was issued, appeal rights provided. a copy of the report was read and given to the administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260129165908
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: AMERICAN SIKH CARE FACILITY
FACILITY NUMBER: 392701619
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2026
Section Cited
CCR
80019(e)(2,3,4)
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80019 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility:
(2) Obtain a California clearance or a criminal record exemption as required by the Department or
(3) Request a transfer of a criminal record clearance as specified in Section 80019(f) or
(4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 80019.1(r), unless, upon request for the transfer, the Department permits the individual to be employed, reside or be present at the facility.
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The persons will be finger printed before they work or reside in the facility again. A confirmation of the finger prints cleared by the department will be sent to the LPA. noel.wolfpetersen@dss.ca.gov
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This requirement was not met as evidenced by: administrator interview and record review where the fingerprinting for the facility was not complete for 2( one resident and one staff). This presents an immediate risk to health saftey and personal rights of the persons 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: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC9099 (FAS) - (06/04)
Page: 3 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
01/29/2026 and conducted by Evaluator Noel Wolf Petersen
COMPLAINT CONTROL NUMBER: 27-AS-20260129165908

FACILITY NAME:AMERICAN SIKH CARE FACILITYFACILITY NUMBER:
392701619
ADMINISTRATOR:SOHI, JASVIR SINGHFACILITY TYPE:
740
ADDRESS:1975 ERICKSON CIRCLETELEPHONE:
(209) 808-3716
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 4DATE:
02/03/2026
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Jasvir SohiTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff do not accord privacy to resident(s) in care.
Staff do not safeguard resident(s) confidentiality while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility on 2/3/2025 at 1:45pm to conduct a complaint investigation. LPA met with administrator Jasvir Sohi and explained the purpose of the visit.
Per a record review of the clients files, resident exhibits a wandering behavior, per administor interview the client ends up all over the facility and the staff is aware to prevent unsafe wandering, and wandering that would sometimes end up in the private rooms of other residents. To the extent that wandering risks the privacy of other clients, the administrator will provide yearly training to the staff to prepare themelves to observe and intervene as necessary.
As to residents receiving confidentiality in delivered mail, per administrator interview, one client asked to have the check cashed after the mail was received, which was documented int the P+I as recieved and immediately dispersed. 1 Client interviewed has dementia, but responded that she has not recived opened mail. No other residents report recieving opened mail.
Continued on c page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20260129165908
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: AMERICAN SIKH CARE FACILITY
FACILITY NUMBER: 392701619
VISIT DATE: 02/03/2026
NARRATIVE
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LPA interviewed 2clients and 2 staff. 1 client has visitors at the time of the LPA's visit, another 1 client were taking naps.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A copy of the report was read and given to staff, a copy of the appeal rights was provided. and exit interview was conducted.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5