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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 032701486
Report Date: 07/30/2025
Date Signed: 07/30/2025 02:08:31 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
07/21/2025 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20250721123655
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:
07/30/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jonathan LiTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee allowed use of video surveillance with an audio component.
INVESTIGATION FINDINGS:
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On 7/30/2025, Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct a complaint follow-up visit and deliver the findings regarding the allegation noted above. LPA met with Licensee/Administrator Jonathan Li and stated the purpose of the visit.

The investigation into the above allegation consisted of interviews and record reviews.

Per interviews, clients reported an incident where the Ring doorbell at the kitchen door captured voices from inside the facility. According to a client in care, on the day of a party at the care home, they noticed that the Ring doorbell was able to pick up voices from the inside, which was unusual. R1 emphasized that prior to this, the Ring doorbell did not broadcast any audio, and this was the first instance of such an occurrence. Another client confirmed this incident, stating that the voices from the inside were recorded on the same day during the party. It was affirmed that this was a one-time occurrence and that such audio recording had not been heard or broadcasted previously.

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

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
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 5
Control Number 27-AS-20250721123655
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: 07/30/2025
NARRATIVE
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Clients also noted that staff had access to the video recordings, but there was no indication that this access was used to exploit or misuse the footage, nor were any recordings shared inappropriately.

Licensee Jon Li (S2) provided an explanation during the interview, stating that the incident might have occurred because the former staff (S3), may have had the Ring app open on their phone. S2 explained that if S3's phone was open to the app, it could have unintentionally picked up a conversation inside the home, and those outside the facility could have overheard it through the Ring doorbell. S2 further clarified that the Ring doorbell system is designed to record only when it detects motion, and the primary function of the system is to allow communication with individuals at the door.

During an observation on July 25, 2025, LPA conducted a test of the Ring Doorbell system. LPA rang the doorbell at the front door, and S2 was able to communicate through the app, confirming that the system allowed two-way audio. While this confirmed that the device has the capacity to record and broadcast audio, the issue remains that the use of audio was not intentional or part of regular practice.

Additionally, there is not preponderance of evidence suggesting that the Licensee or staff have intentionally or regularly used the Ring doorbell for unauthorized surveillance or to record audio without proper notification or consent. 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.

No deficiencies were cited as a result of this visit. An exit interview was conducted, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 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
07/21/2025 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20250721123655

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:
07/30/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jonathan LiTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee did not ensure proper infection control practices were followed
INVESTIGATION FINDINGS:
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On 7/30/2025 Licensing Program Analyst, Arvin Villanueva (LPA) arrived unannounced at this facility to conduct a complaint follow-up visit and deliver the findings regarding the allegation noted above. LPA met with Licensee/Administrator Jonathan Li (S2) and stated the purpose of the visit.

The investigation into the above allegation consisted of interviews and record reviews.

According to interviews with client, it was reported that Staff (S1) exhibited coughing while preparing food with another client. Clients explicitly stated that they requested S1 to wear a mask, but this was not done immediately. Additionally, it was mentioned that S1 coughed directly on two clients in care. Despite these concerns, S1 refused to quarantine, continuing to work until 8:00 PM that evening. When asked about the cause of the coughing, S1 claimed that it was due to something S1 ate.
{Con't to 9099-C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20250721123655
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: 07/30/2025
NARRATIVE
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Another client also corroborated the situation, stating that S1 was coughing while cooking and that clients had to remind S1 to wear a mask.

Additionally, a review of email correspondence between the Licensee (S2) and former Administrator (S3) on July 16, 2025, confirms that S2 spoke with S1 and acknowledged that S1 had a minor cough, which S1 attributed to something S1 had eaten. During this conversation, S2 advised S1 to wear a mask.

Furthermore, a subsequent email exchange on July 22, 2025, between S2 and S3 confirms that S1 underwent retraining on the facility’s infection control policies and procedures following a resident complaint. The training specifically addressed the importance of proper hand hygiene and the use of PPE, highlighting that these practices are essential in preventing the spread of infection.

Based on evidence gathered through interviews and record reviews, support the allegation that the licensee did to ensure proper infection control practices were followed by a staff member. Therefore, the allegation is SUBSTANTIATED.
A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met.

Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted and a copy of the report and appeal rights were provided to facility.



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

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250721123655
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: 07/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2025
Section Cited
CCR
85095.5(a)
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Infection Control Requirements: A licensee shall ensure that infection control practices are maintained.

This requirement is not met as evidenced by:
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Corrected prior to this visit: Licensee proivded training to staff regarding infection control practices.
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Based on interviews and record reviews, licensee did not ensure compliance with the citation noted above. Staff on duty was coughing while performing direct care and supervision to residents in care without immediately wearing mask when requested by residents. This poses a potential health, safety and personal risks to persons in care.
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Per discussion, Licensee will ensure infection control practices are inplemented when necessary.
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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: 07/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5