032701486-9-18-2025-27-AS-SRIN-DM425J-20251002170535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 032701486
Report Date: 09/18/2025
Date Signed: 09/18/2025 04:25:42 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
09/04/2025 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20250904170001

FACILITY NAME:	LIVEWELL CARE HOME LLC		FACILITY NUMBER:	032701486
ADMINISTRATOR:	JONATHAN LI		FACILITY TYPE:	735
ADDRESS:	290 GOLD STRIKE CT		TELEPHONE:	(302) 893-3498
CITY:	SUTTER CREEK	STATE: CA	ZIP CODE:	95685
CAPACITY:	4	CENSUS: 4	DATE:	09/18/2025
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Jonathan "Jon" Li		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff yelled at client.
Facility does not have sufficient food supply.

INVESTIGATION FINDINGS:

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On 9/18/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived at this facility to conduct a follow up complaint visit regarding the allegations noted above. LPA met with Jon Li and stated the purpose of the visit.

Allegation – facility staff yelled at a client:
The investigation into this allegation consisted of interviews and record reviews.
Through interviews, one resident reported that they have never witnessed staff yelling at any residents in care and stated that staff have never yelled at them personally. Resident expressed no concerns with any current facility staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250904170001

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: LIVEWELL CARE HOME LLC	FACILITY NUMBER: 032701486
	VISIT DATE: 09/18/2025

NARRATIVE

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Another resident recalled an incident involving a gas leak at the facility, during which an emergency evacuation took place and the fire department responded. Resident stated that during the evacuation, one staff member, identified as S2 raised their voice and described it as yelling. Resident confirmed that no other staff yelled that day, and stated that staff do not regularly yell at residents.
Through interview and record review, S1 reported that he conducted an internal investigation into the incident. S1 interviewed staff member (S2) who was present during an emergency incident and found no evidence that S2 yelled at residents during the evacuation. However, S1 acknowledged that he did not interview S3, as S1 was not aware S3 was involved in the allegation.
While one resident reported that a staff member raised their voice during an emergency situation, there is insufficient evidence to confirm that the staff conducted inappropriate yelling or that it occurred in a manner inconsistent with emergency response protocols. No other residents reported similar concerns, and staff interviews and records did not support the allegation.
Based on the information gathered, the allegation that a staff member yelled at a resident is UNSUBSTANTIATED.

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Allegation - Facility does not have sufficient food supply:
The investigation into this allegation consisted of interviews, observations, and record reviews.
Interviews:
Resident reported that there is always food available at the facility. It was explained that if food items ever run out, both staff and residents collaboratively make a list of necessary items to be purchased during the next grocery day. Furthermore, alternative food options are always available if a specific food item is out of stock. Additionally, resident stated that food preparation is based on the preferences of the residents.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250904170001

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: LIVEWELL CARE HOME LLC	FACILITY NUMBER: 032701486
	VISIT DATE: 09/18/2025

NARRATIVE

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Staff stated that the facility typically buys groceries in bulk on weekends and maintains a weekly menu that is reviewed and planned with input from the residents. Staff confirmed that if any specific food items are unavailable, staff can easily go to the store to purchase the necessary items.
Observations:
On 9/9/25, LPA Villanueva conducted a tour of the facility’s kitchen and food storage areas. The kitchen refrigerator and freezer were found to be fully stocked with a variety of food items, including fresh vegetables and fruits. The kitchen pantry also contained a diverse selection of non-perishable food items and snacks, specifically assigned to each resident. In addition to the kitchen storage, the facility had two additional refrigerators and freezers located in the garage area and the exercise room, both of which were fully stocked with various food items.
Record Review:
The LPA reviewed several facility records, including Client Council Meeting notes from 7/1/25 and 8/25/25. These meetings involved discussions on menu requests, special food preferences, and supply needs. The staff and clients actively participated in planning meals and addressing any specific food-related requests or issues. The provided menu calendar was also reviewed, showing a variety of meals served across different days of the week, with distinct breakfast, lunch, and dinner options. The menu included items such as waffles, fruits, pancakes, bacon, chicken wraps, turkey and cheese sandwiches, lasagna, salads, mac and cheese, and pizza. Additionally, healthy snacks, fruits, and beverages like milk, juice, tea, and coffee were offered daily.

Based on the information gathered through interviews, observations, and record reviews, there is no preponderance of evidence to support the allegation of insufficient food supply at the facility. Therefore, the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened the preponderance of evidence does not prove it.

Exit interview was conducted with Jon, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025

LIC9099 (FAS) - (06/04)

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