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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701087
Report Date: 12/19/2024
Date Signed: 12/19/2024 03:33:01 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
12/06/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20241206152840
FACILITY NAME:BONNIE'S CARE HOMEFACILITY NUMBER:
502701087
ADMINISTRATOR:LACY VINCENTFACILITY TYPE:
740
ADDRESS:2608 VENEMAN AVENUETELEPHONE:
(209) 248-7663
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 5DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maria AraizaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of adequate food service
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/19/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegstions. LPA Jensen met with care provider Sandra Williams and explained the purpose of today's visit. Maria Araiza arrived on the scene shortly after.

LPA Jensen inspected the food supply and observed 2 days worth of perishable food and 7 days worth of non-perishable food. The non-perishable food consisted of a limited nnumber of canned goods and dry food plus a 30 day supply of emergency food for 1 person. Based on LPA Jensen's observation of the food supply on 2 seperate occassions the allegation of "lack of adquate food service" is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it. The posted menu for this day states that chicken fajita tacos will be served for dinner but the facility lacks the ingredients to make what's on the menu. Technical assistance was provided.
An exit itervew was conducted and a copy of this report was provided.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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
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
12/06/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20241206152840

FACILITY NAME:BONNIE'S CARE HOMEFACILITY NUMBER:
502701087
ADMINISTRATOR:LACY VINCENTFACILITY TYPE:
740
ADDRESS:2608 VENEMAN AVENUETELEPHONE:
(209) 248-7663
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 5DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maria AraizaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/19/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegstions. LPA Jensen met with care provider Sandra Williams and explained the purpose of today's visit. Maria Araiza arrived on the scene shortly after.

On 8/29/24 facility staff called 911 because resident 1 (R1) was complaining of pain to his head. LPA Jensen verified with R1's responsible party that facility staff reported this event to her by telephone and she agreed that R1 should be taken to the local hospital's emergency department. LPA Jensen verified that an incident report was also sent to the Department. Based on LPA Jensen's verification that an incident report was sent to the Department in a timely manner the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
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 2