032701486-10-23-2025-27-AS-SRIN-DMR4C3-20251023185827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 032701486
Report Date: 10/22/2025
Date Signed: 10/23/2025 09:08:16 AM

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
10/06/2025 and conducted by Evaluator Arvin Villanueva

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20251006094606

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:	10/22/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jonathan Li		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are administering discontinued medications to client in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 10/22/2025, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct a follow-up complaint visit 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 included interviews and record reviews.

The primary focus was on resident R1 and a medication that was meant to be discontinued, but which staff continued to administer.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

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-20251006094606

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: 10/22/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interviews were conducted with care staff members and the administrator, Jonathan Li (AD). Care staff interviews indicated the medication was a cream for a toenail problem, given to a resident (R1). Care staff explained that they usually receive about any changes in medications from the administrator. They said they didn’t know the medication had been stopped because they hadn’t been told in time, so they kept giving the medication to R1.
The administrator explained that R1’s parents are responsible for all of R1’s medical and dental appointments. Since taking over as the new administrator, AD hasn’t gone to those appointments. He depends on R1’s parents to send him updates after visits, including any medication changes. Jon confirmed that the cream (Tolnaftate) was stopped back in March 2025, except for a brief period from 10/2/25 to 10/4/25, when the medication was mistakenly resumed based on an “After Visit Summary” received from R1’s parents. This version of the summary, printed on 9:57 AM on 10/2/25, listed Tolnaftate in the active medication list, leading staff to believe the medication was reinstated. When AD sought clarification and received a second version of the same After Visit Summary, printed later at 10:31 AM, it clearly indicated that Tolnaftate was discontinued. The medication was immediately stopped upon this clarification.
A review of R1’s medical records support this timeline. The Medication Administration Record (MAR) shows that Tolnaftate was regularly administered from December 1, 2024, through March 25, 2025, and not administered from March 26, 2025, through October 1, 2025. It was briefly administered again between October 2, 2025, and October 4, 2025, during the period of confusion regarding the medication's status. Additionally, R1’s Physician’s Report dated April 10, 2025, indicates that R1 is capable of self-care, including managing own medications.
Based on the interviews and records reviewed, there is insufficient evidence to support the allegation that staff were knowingly administering a discontinued medication to R1. The temporary administration of the Tolnaftate cream in October 2025 was due to conflicting documentation and was promptly corrected once accurate information was received. Therefore, the allegation is unsubstantiated.
Technical Violation was issued and advisory was provided to Administrator to ensure any new medication orders are clarified and confirmed by residents' prescribing physician before residents start the medication.
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: 10/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2