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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 097001962
Report Date: 08/19/2025
Date Signed: 08/19/2025 12:37:25 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
08/15/2025 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20250815111340
FACILITY NAME:OAK GROVE SENIOR CAREFACILITY NUMBER:
097001962
ADMINISTRATOR:OMITA KAHNFACILITY TYPE:
740
ADDRESS:2920 TAM O'SHANTER DRIVETELEPHONE:
(916) 939-0962
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:6CENSUS: 5DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Jennifer HinchTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared individuals are present on the facility grounds
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/19/25, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to open and investigate complaint findings into the allegations listed above and met with Administrator Jennifer Hinch. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:
Based on documents obtained and statements reviewed, the department determined that the individual in question does not spend time alone with residents. Based on the Health and Safety code this individual is hired to do maintenance around the facility, is a 1099 third-party contractor powered by ADP; therefore, is exempt from Criminal Record Clearance. One staff interviews (1) indicated that W1 is not left alone with residents. Two resident interviews (2) expressed no concerns with W1. Based upon the information obtained during investigation, 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.

Exit interview conducted. Report left with facility.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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