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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700574
Report Date: 09/01/2026
Date Signed: 09/01/2026 12:10:32 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
08/25/2026 and conducted by Evaluator Graham Gunby
COMPLAINT CONTROL NUMBER: 59-AS-20260825122414
FACILITY NAME:ANSEL PARK SENIOR LIVING COMMUNITYFACILITY NUMBER:
312700574
ADMINISTRATOR:PAYNE, KEITHFACILITY TYPE:
740
ADDRESS:1200 ORCHID DRIVETELEPHONE:
(916) 250-0770
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:100CENSUS: 82DATE:
09/01/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director - Aileen EnriquezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Unqualified administrator operating the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Graham Gunby arrived on 09/01/2026 to open and deliver findings to a complaint the department received on 08/25/2026. LPA met with Executive Director, Aileen Enriquez and explained the purpose of this visit.
Based on observation and review of facility records, the licensee failed to maintain a qualified and currently certified administrator. The licensee designated an administrator who did not possess an active administrator certificate. The licensee did not provide documentation demonstrating that the designated administrator had completed an approved administrator certification program. This failure resulted in the facility operating without a qualified and currently certified administrator, as required by Title 22, Section 87405(a)
Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview was conducted and the report was provided to Executive Director Aileen Enriquez.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
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-20260825122414
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: ANSEL PARK SENIOR LIVING COMMUNITY
FACILITY NUMBER: 312700574
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2026
Section Cited
CCR
87405(a)
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Administrator Qualifications and Duties.
All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person....This requirements was not met based on:
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The licensee shall provide this LPA with documentation demonstrating that the designated administrator meets the administrator certification requirements. Documentation shall include:
Proof of successful completion of the administrator certification program and a current administrator certificate once certification is completed.
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The Licensee did not designate a qualified and currently certified administrator.
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Until the designated administrator obtains and maintains a current administrator certificate, the licensee shall designate a qualified individual who holds a current administrator certificate to serve as the facility administrator.
The licensee shall submit the required documentation to LPA Gunby by 10/01/2026 and shall maintain documentation at the facility demonstrating that the administrator remains currently certified.
The licensee shall ensure that any future administrator maintains a current administrator certificate and meets all applicable administrator qualification requirements before assuming responsibility for the facility.
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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.
SUPERVISOR'S NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2