092700445-6-18-2025-59-AS-LMUZ-DHWNYW-20250623105324

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 092700445
Report Date: 06/18/2025
Date Signed: 06/18/2025 02:18:47 PM

Unfounded

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
04/14/2025 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20250414123809

FACILITY NAME:	PAVILION AT EL DORADO HILLS, THE		FACILITY NUMBER:	092700445
ADMINISTRATOR:	WALL, ALISON M		FACILITY TYPE:	740
ADDRESS:	2288 FRANCISCO DR		TELEPHONE:	(916) 542-3452
CITY:	EL DORADO HILLS	STATE: CA	ZIP CODE:	95762
CAPACITY:	64	CENSUS: 39	DATE:	06/18/2025
		UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	AED Bridget Botez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident poses a risk to other residents in care.
Staff do not ensure residents are provided a safe and healthy environment.
Staff do not ensure facility doors are in good repair.
Staff do not ensure facility has adequate supplies.
Staff does not ensure facility is kept clean.

INVESTIGATION FINDINGS:

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On June 18, 2025, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with AED Bridget Botez.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

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 59-AS-20250414123809

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: 06/18/2025

NARRATIVE

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Resident poses a risk to other residents in care.
Staff do not ensure residents are provided a safe and healthy environment.
Based on observation, record review, and statements reviewed, the department determined that there was insufficient evidence that the facility has a resident that poses a risk to other residents and that staff do not ensure residents are provided a safe and healthy environment. Based on three (3) staff interviews, three (3) resident interviews, and department observation, residents and staff stated their needs are being met and that they feel safe; therefore, the allegations are UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Staff do not ensure facility doors are in good repair.
Staff do not ensure facility has adequate supplies.
Based on observation and statements reviewed, the department determined that there was insufficient evidence that the facility’s doors are not in good repair as they all were observed to be working at the time of visit on 4/14/25 and 4/29/25. Based on interviews with three (3) staff and three (3) residents, the Department determined that there are adequate supplies for residents in care. Staff have adequate supplies per resident needs and residents did not verbalize any shortage of any supply items; therefore, the allegations are UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

Staff does not ensure facility is kept clean.
Based on three (3) staff interviews, three (3) resident interviews, and department observation, the department observed the facility to be clean and sanitary. During department visits on 4/14/25 and 4/29/25 the facility did not observe to be malodorous including resident rooms, common areas and restrooms. Residents stated their needs are being met and that they feel safe. Staff interviews indicated that the facility is kept clean and sanitary without and concerns; therefore, the allegation is 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. Report left with facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia Muscan	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025

LIC9099 (FAS) - (06/04)

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