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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700581
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:31:33 PM

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
03/11/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250311153725
FACILITY NAME:GATE OF BEAUTIFUL II, THEFACILITY NUMBER:
502700581
ADMINISTRATOR:NICOLE ELLFACILITY TYPE:
740
ADDRESS:3300 SHARON AVETELEPHONE:
(209) 526-2425
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:6CENSUS: 3DATE:
03/19/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nicole Ell TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff did not communicate with residents’ authorized representative about medication changes.
INVESTIGATION FINDINGS:
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On 03/19/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Nicole Ell and explained the purpose of the visit. The purpose of the visit was to inform the facility and its representative that a complaint has been filed against it at this time.

Current census was 3. 3 out 3 residents were out of the facility. A brief interview with FDA Ell was conducted.
It was alleged that staff did not communicate with residents' authorized representative about medication changes. Based on interviews conducted, it was learned that R1 had a change in anxiety medication on 1/07/2025, however was still prescribed a seperate medication for anxiety. This medication change was reviewed by the doctor as well as the resident's authorized representative. On 01/08/2025, the facility called the doctors office to clarify the resident's medication. However, it was denied that there was were no medication changes where the resident's representative was not notified through the doctors office.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
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-20250311153725
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: GATE OF BEAUTIFUL II, THE
FACILITY NUMBER: 502700581
VISIT DATE: 03/19/2025
NARRATIVE
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An addition, an interview conducted disclosed that there were no reports that the facility called for an increase with medication. However, it was reported that the doctors office does not approve any medications with notification to the responsible party. A review of the facility records do not indicate any record that the facility attempted to increase the resident's medication without the responsible parties knowledge. Based on the information gathered, it is unclear if the facility did not notify the responsible party of any medication changes.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2