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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 095920251
Report Date: 04/28/2026
Date Signed: 04/28/2026 02:25:00 PM

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
04/12/2026 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20260412101534
FACILITY NAME:KALA SPRINGSFACILITY NUMBER:
095920251
ADMINISTRATOR:RAMIREZ OROZCO, JESUSFACILITY TYPE:
738
ADDRESS:2590 CONSOLATION CTTELEPHONE:
(916) 886-3765
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY:4CENSUS: 3DATE:
04/28/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Interim Assistant Administrator Joshua RossTIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Staff do not provide adequate supervision to the residents in care.
INVESTIGATION FINDINGS:
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On 04/28/2026, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Interim Assistant Administrator Joshua Ross.

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**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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 3
Control Number 59-AS-20260412101534
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: KALA SPRINGS
FACILITY NUMBER: 095920251
VISIT DATE: 04/28/2026
NARRATIVE
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Staff do not provide adequate supervision to the residents in care.
The Department conducted interviews and reviewed facility records, including incident reports, service plans, and supervision documentation. The investigation revealed that staff did not provide adequate supervision to R1 to meet their assessed needs and ensure their health and safety. On April 5, 2026, at approximately 11:02 a.m., staff failed to provide adequate supervision to R1 when R1 exited from the facility and ran to a neighboring residence and entered without authorization. Staff attempted to redirect R1 but were unsuccessful resulting in R1 exiting the facility. This failure to provide adequate supervision created an immediate risk to the health and safety of the resident. This is a violation of Title 22, California Code of Regulations, requiring the facility to provide care and supervision appropriate to residents’ needs, and ensure health and safety at all times. Therefore, the allegation is determined to be substantiated.

Deficiencies are cited pursuant to California Code of Regulations, Title 22, Section 80078(a) and documented on the attached LIC809D.

Exit interview conducted, appeal rights and a copy of this report were left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260412101534
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: KALA SPRINGS
FACILITY NUMBER: 095920251
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/29/2026
Section Cited
CCR
80078(a)
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80078 (a) Responsibility for Providing Care and Supervision, (a)The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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The licensee shall submit a written Plan of Correction detailing specific steps taken to correct the deficiency. POC due 04/29/2026.
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Based on record review, it was determined that facility did not provide adequate supervision to R1, which poses an immediate health and safety risk to residents in care.
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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: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3