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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 01:23:03 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
10/15/2025 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20251015150704
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:
01:22 PM
ALLEGATION(S):
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Staff caused injuries to resident in care
Staff restrained resident in care
Staff are not properly trained
Staff did not change residents in care for an extended period of time
Staff did not provide feeding assistance to residents in care
Staff spoke inappropriately to residents in are
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 3
Control Number 59-AS-20251015150704
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 caused injuries to resident in care
Staff restrained resident in care
The Department conducted interviews with staff members and reviewed records regarding allegations above. Staff interviews revealed that they were not aware of any injuries or restraining’s of any residents in care; therefore, the above 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.

Staff are not properly trained
The Department conducted interviews with staff members and reviewed records regarding the allegation above. Staff interviews revealed that staff have adequate training (on boarding and ongoing) regarding infection control guidelines and other required topics and there were no issues. Staff interviews also reflected that the facility has adequate supplies of PPE and other care items to take care of residents. Record reviews indicated that the facility has all the required documentation regarding staff training per Title 22 Regulations, therefore these allegations were 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.

Staff did not change residents in care for an extended period of time
Staff did not provide feeding assistance to residents in care
The department conducted interviews, facility observation and record review to investigate the above allegation. 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 10/20/25 and 10/28/25, the Department observed that staff were attentive to residents’ care needs and helping them with their care needs, including feeding and toileting. Staff interviews reflected the fact that the facility provides adequate staffing and there were no issues with staff who do not help residents with feeding and toileting. Staff stated that they were assisting residents with toileting needs every 2 hours or as needed without any issues. 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.

Continued on page 2 ...
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 3
Control Number 59-AS-20251015150704
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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Page 2 ...

Staff spoke inappropriately to residents in care
The department interviewed six (6) staff and attempted three (3) resident interviews during a complaint investigation. The department conducted a tour of the facility on 10/20/25 and 10/28/25 and conducted interviews with residents and staff. Interviews indicated that all staff treat all residents with dignity and respect and do not speak inappropriately to residents. During a facility tour on 10/20/25 and 10/28/25, facility staff were observed to be attentive to residents’ needs and treating residents with dignity and respect. During residents’ interviews, residents did not express any concern in this area. Based on facility tours, interviews and observation, the department found that there is no evidence that facility staff do not treat residents with respect or speak inappropriately to residents; 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: 3 of 3