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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 032701486
Report Date: 04/17/2025
Date Signed: 04/17/2025 04:23:14 PM

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
04/08/2025 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20250408150005
FACILITY NAME:LIVEWELL CARE HOME LLCFACILITY NUMBER:
032701486
ADMINISTRATOR:KAREN ORRFACILITY TYPE:
735
ADDRESS:290 GOLD STRIKE CTTELEPHONE:
(302) 893-3498
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY:4CENSUS: 4DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Karen OrrTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff working with clients with no fingerprint clearance/not associated to the facility,
INVESTIGATION FINDINGS:
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On 4/17/2025, at 2:30pm, Licensing Program Analyst Arvin Villanueva (LPA) arrived unannounced at this facility to conduct the initial complaint visit regarding the allegation noted above. Upon arrival, LPA noted there was no one is present at the facility. LPA spoke with the current Administrator, Karen Orr (AD) over the phone and explained the purpose of this visit. AD confirmed no one at the facility until later. LPA waited at the back of the facility until AD arrived at 3:53pm, along with 2 clients in care.

Prior to today's visit, LPA conducted interviews with relevant parties and record reviews including staff member's (S1) files.
Interviews revealed that S1 worked at Livewell Care Home on 4/1/2024 and 4/2/2025, both days falling under a period when S1’s criminal background clearance was incomplete. S1 confirmed that Department of Justice (DOJ) background check was cleared, but the FBI background check did not pass. During the two days of work, S1 was in training, with guidance provided by licensee Jonathan Li.

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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-20250408150005
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: 04/17/2025
NARRATIVE
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Interview also revealed that S1 was never left alone with clients during this period, with both Jonathan Li and the home manager, Karen Orr, present during these dates. S1 also confirmed that S1 was given a key to the home and had performed tasks such as preparing dinner for clients and administering medication to one resident under the direct supervision of Jonathan Li. Interview also revealed that S1 was paid for the two days worked.
On contrary, other interviews also revealed that S1 was scheduled on Tuesdays and Wednesdays when Staff_2 (S2) was off. It was also revealed through interviews that S1 worked independently during these shifts.
A review of the Guardian and LIS records revealed that S1's background check was still in "in-process" status as of 4/2/2025. Records also indicated that the California Department of Social Services (CDSS) notified that a criminal record exemption was required for S1. The status from the Care Provider Management Branch (CPMB) explicitly noted that S1 did not pass the necessary background check and would require an exemption to continue working with clients at the facility. The records also confirmed that S1 was scheduled to work from 2:45 pm to 7:45 pm on the two days in question, further substantiating the claim that S1 worked at the facility without proper clearance.
Valley Mountain Regional Center representative (W1) confirmed that an investigation was conducted, during which it was established that S1 worked at the facility on 4/1/25 and 4/2/25 prior to receiving the necessary criminal background clearance. W1’s investigation verified that S1 had worked independently with clients, despite not having received clearance or an approved exemption.
Furthermore, through interviews confirmed that S1 had not returned to the facility after 4/6/2025, when it was made clear that S1 did not pass the background check.
Based on the gathered information, there is a preponderance of evidence that S1 worked at Livewell Care Home on 4/1/2024 and 4/2/2025 without the required criminal background clearance prior to working with clients in care. Therefore, the above allegation was SUBSTANTIATED. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are cited on the 9099D during this visit.
A civil penalty in the amount of $100 per day for 2 days for the total of $200 is hereby assessed for the presence of an employee without proper background clearance.
Exit interview was conducted and a copy of this report and appeal rights were provided.


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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250408150005
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2025
Section Cited
CCR
80019(e)(2)
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Criminal Record Clearance: 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: Obtain a California clearance or a criminal record exemption as required by the Department.
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Prior to this visit, it was confirmed that S1 is no longer employed at this facility.
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This requirement is not met as evidenced by:
Based on interviews and record reviews, the licensee did not comply with the regulation cited above. It was determined that staff (S1) worked at this facility for 2 days without background clearance. This poses an an immediate health and safety risk.
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Per discussion, licensee agrees to review 22 CCR requirements for criminal background clearances, and to write a statement acknowledging the requirement by the POC due date.
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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: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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