092700445-9-8-2025-59-AS-LMUZ-DLEUZY-20250911160220

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 092700445
Report Date: 09/08/2025
Date Signed: 09/08/2025 12:33:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/13/2025 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20250813080748

FACILITY NAME:	PAVILION AT EL DORADO HILLS, THE		FACILITY NUMBER:	092700445
ADMINISTRATOR:	NICHOLS, MARTIN		FACILITY TYPE:	740
ADDRESS:	2288 FRANCISCO DR		TELEPHONE:	(916) 542-3452
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	64	CENSUS: 55	DATE:	09/08/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator Michael Owens		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff did not provide resident with assistance as requested
Staff do not ensure residents' rooms are clean and sanitary
Staff do not ensure residents' have clean bedding
Staff do not ensure residents' hygiene needs are being met
Staff do not ensure that residents' laundry is done in a timely manner

INVESTIGATION FINDINGS:

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On 9/8/25, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Michael Owens. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:
The department conducted interviews, facility observation and record review to investigate the above allegations. During interviews with facility staff, it has been discovered that facility provided appropriate care to the residents based on resident’s documented needs and service plans. During department visits on 8/19/25 and 9/4/25, the Department observed that staff were attentive to residents’ care needs. Staff interviews reflected that the facility provides adequate assistance and there were no issues with staff who were not helping residents with their care needs. Staff stated that they assist residents with their needs, clean resident rooms and bedding, and do laundry as needed; therefore, these allegations are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.Exit interview conducted and report left with facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/13/2025 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20250813080748

FACILITY NAME:	PAVILION AT EL DORADO HILLS, THE		FACILITY NUMBER:	092700445
ADMINISTRATOR:	NICHOLS, MARTIN		FACILITY TYPE:	740
ADDRESS:	2288 FRANCISCO DR		TELEPHONE:	(916) 542-3452
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	64	CENSUS: 55	DATE:	09/08/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator Michael Owens		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility is malodorous
Staff did not provide first aid to resident after a fall
Staff are not following reporting requirements

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025

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 3

Control Number 59-AS-20250813080748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PAVILION AT EL DORADO HILLS, THE	FACILITY NUMBER: 092700445
	VISIT DATE: 09/08/2025

NARRATIVE

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Facility is malodorous
Department investigated allegation, “Facility is malodorous”. The facility was toured on 9/4/25 and several other occasions and observed to be clean, sanitary, and free from odor. Resident rooms, common areas, kitchen area, and dining room were toured. Four (4) staff members were interviewed in which they stated housekeeping and other staff keep the facility clean and free from odor. Staff stated due to resident incontinent care needs, at times there may be a temporary smell, but staff take care of the problem in a timely manner. Due to interviews and observation, the department finds allegation to be UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Staff did not provide first aid to resident after a fall
Staff are not following reporting requirements
The department conducted interviews, facility observation and record review to investigate the above allegations. During interviews with facility staff, it has been discovered that facility provides first aid to residents after a fall as well as call 911. Additionally, the department confirmed that incident reports were sent to CCLD; therefore, the department finds allegations to be UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and report left with facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025

LIC9099 (FAS) - (06/04)

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