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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 01:26:00 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
10/29/2025 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20251029111640
FACILITY NAME:PAVILION AT EL DORADO HILLS, THEFACILITY NUMBER:
092700445
ADMINISTRATOR:DELGADO, KIMFACILITY 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:
01:25 PM
ALLEGATION(S):
1
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9
Questionable death
Staff did not seek timely medical attention for residents in care
Staff did not ensure that the resident’s bandages were changed by an appropriately skilled professional
Staff did not provide shower assistance to residents in care
Staff did not wash resident’s soiled clothing items
Staff did not change resident’s brief in a timely manner
Staff did not sanitize the facility’s contaminated areas
INVESTIGATION FINDINGS:
1
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13
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-20251029111640
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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Questionable death
Staff did not seek timely medical attention for residents in care
Staff did not ensure that the resident’s bandages were changed by an appropriately skilled professional
Records were reviewed regarding the death of R1. Based on documentation, R1 was on Hospice at the time of death. Records indicated that Hospice nurses were changing residents’ bandages regularly and seeking medical attention as needed. Facility staff contacted Hospice. Once Hospice arrived at the facility, R1 was unresponsive and pronounced deceased. R1’s death certificate lists cause of death. The above 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 did not provide shower assistance to residents in care
Staff did not wash resident’s soiled clothing items
Staff did not change resident’s brief in a timely manner
Staff did not sanitize the facility’s contaminated areas
The department conducted interviews, facility observation and record review to investigate the above allegations. During interviews with facility staff and residents, 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 11/03/25, the Department observed that staff were attentive to residents’ care needs and helping them with their care needs. Staff interviews reflected that the facility provides adequate staffing and there were no issues with staff who are not helping residents with their care needs. Staff stated that they were assisting residents with showers, laundry, sanitation, and toileting needs every 2 hours or as needed. Resident interviews did not express any concerns in this area; therefore, these allegations are found 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