<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 095920187
Report Date: 07/06/2026
Date Signed: 07/06/2026 11:12:07 AM

Substantiated


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
07/06/2026 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20260706083643
FACILITY NAME:PAVILION AT EL DORADO HILLS, THEFACILITY NUMBER:
095920187
ADMINISTRATOR:DELGADO, KIMBERLYFACILITY TYPE:
740
ADDRESS:2288 FRANCISCO DRTELEPHONE:
(916) 542-3452
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:64CENSUS: 62DATE:
07/06/2026
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Administrator Kim DelgadoTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff blocking door from the outside
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 6, 2025, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to open complaint into the allegation listed above and met with Administrator Kim Delgado.
Upon arrival at the facility, LPA observed a portable door reinforcement bar jamming one of the exterior exit doors of the facility resulting in residents being unable to leave through this door. The ED stated the facility is utilizing the door jammer due to malfunctions of the alarm system. A referral was made to the local fire jurisdiction to determine if the delay egress system is working properly. Based on Department observation facility did not ensure that exit doors were free from obstruction, which poses an immediate health, safety, or personal rights risk to persons in care. The preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Immediate civil penalty of $500.00 was issued today. Failure to correct shall result in civil penalties.
Appeal Rights given to administrator. A copy of this report has been provided to facility. Exit interview conducted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2026
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-20260706083643
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: 095920187
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/07/2026
Section Cited
CCR
87307(d)(6)
1
2
3
4
5
6
7
87307 Personal Accommodations and Services (d)(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.
... This requirement was not met as evidenced by ...
1
2
3
4
5
6
7
Licensee/Administrator shall ensure all exits are free of obstruction immediately and send a plan to LPA by 7/7/26 on how facility will ensure safety of residents without obstructing any exits.
8
9
10
11
12
13
14
LPA observed a portable door reinforcement bar jamming the exterior exit door of the facility resulting in residents being unable to leave through this door, which poses an immediate health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2