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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 092700445
Report Date: 11/24/2025
Date Signed: 11/24/2025 01:19:22 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
09/16/2025 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20250916141612
FACILITY NAME:PAVILION AT EL DORADO HILLS, THEFACILITY NUMBER:
092700445
ADMINISTRATOR:OWENS, MICHAELFACILITY TYPE:
740
ADDRESS:2288 FRANCISCO DRTELEPHONE:
(916) 542-3452
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:0CENSUS: 56DATE:
11/24/2025
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Administrator Kim DelgadoTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to residents in care
Staff did not ensure that residents’ hygiene care needs are met at the facility
Staff did not provide sufficient activities for residents in care
Staff did not provide adequate laundry services to residents in care
Staff did not clean resident rooms
Facility is unsanitary
INVESTIGATION FINDINGS:
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On 11/24/2025, Licensing Program Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Kim Delgado.

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:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
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 59-AS-20250916141612
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: 11/24/2025
NARRATIVE
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Staff did not provide adequate supervision to residents in care
Based on six staff interviews (6) it was determined that residents are provided with adequate care and supervision. During the interview process it was reported that staff check on residents every two hours and as needed. It was reported that staff are conscience of keeping the residents clean and dry. Staff are aware of resident needs for adequate care and supervision per their needs and service plan. Interviews did not indicate any concern in proper care and supervision for residents by staff. 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.

Staff did not ensure that residents’ hygiene care needs are met at the facility
Staff did not provide sufficient activities for residents in care
Staff did not provide adequate laundry services to residents in care
Department conducted record review, staff, and resident interviews to investigate this allegation. Six (6) staff interviews indicated that staff were providing all ADL assistance, including activities, adequate laundry services and toileting residents per their needs and service plan. Staff interviews indicated that staff assisted residents with their toileting needs every 2 hours or as needed. Interviews reflected that resident care needs were met by staff and there were no issues to address, therefore the above allegation is 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 clean resident rooms
Facility is unsanitary
Department investigated above allegations. The facility was toured on 9/23/25 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. Six (6) 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.

Exit interview conducted. report left with Administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2