312700959-9-9-2026-59-AS-TORZ-DYLT8L-20261006143029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 312700959
Report Date: 09/09/2026
Date Signed: 09/09/2026 05:11:59 PM

Unsubstantiated

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
06/10/2026 and conducted by Evaluator Kevin Mknelly

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260610160701

FACILITY NAME:	PALMS COURT II		FACILITY NUMBER:	312700959
ADMINISTRATOR:	OGUNDIWIN, ADEOLA		FACILITY TYPE:	740
ADDRESS:	1419 CHAMPION OAKS DR		TELEPHONE:	(559) 349-3057
CITY:	ROSEVILLE	STATE: CA	ZIP CODE:	95661
CAPACITY:	6	CENSUS: 2	DATE:	09/09/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	"MJ" Carera		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff are sleeping during their shifts while in care.
Staff do not respond to calls for assistance in a timely manner.
Staff isolates residents in room for extended periods of time.
Staff are not meeting the needs and services of the residents resulting in hospitalization.

INVESTIGATION FINDINGS:

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On 9/9/26, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator.

LPA conducted records review and interviews.
LPA is unable to find and or meet the preponderance, per policy.

Records review and interviews found that R1 to have needs for emotional support often and physical assist with ADLs. Interviews of care staff found that as a new resident, R1 had some sleep disruptions that staff stated they addressed as needed. R1’s representative/ family member did not return calls for an interview. Though R1’s records stated they were a fall risk, staff stated R1 was unable to get out of bed unassisted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

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-20260610160701

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: PALMS COURT II	FACILITY NUMBER: 312700959
	VISIT DATE: 09/09/2026

NARRATIVE

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The are two live-in staff at the home. Care staff stated that they checked on R1 periodically through the night and there were no apparent unmet needs. Residents are determined by the Administrator to not require an awake night staff.

Interviews conducted found that R1 received regular daytime interaction with staff and family. Though records showed R1 to be regularly confused and wanted to go home, LPA did not find a preponderance of evidence of isolation for R1.

Information provided by facility staff, along with a lack of additional evidence from other requested sources, did not show that a lack of care lead to hospitalization.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator.due to computer technical issues, report emailed for signature.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
06/10/2026 and conducted by Evaluator Kevin Mknelly

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260610160701

FACILITY NAME:	PALMS COURT II		FACILITY NUMBER:	312700959
ADMINISTRATOR:	OGUNDIWIN, ADEOLA		FACILITY TYPE:	740
ADDRESS:	1419 CHAMPION OAKS DR		TELEPHONE:	(559) 349-3057
CITY:	ROSEVILLE	STATE:CA	ZIP CODE:	95661
CAPACITY:	6	CENSUS: 2	DATE:	09/09/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	"MJ" Carera		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident room door locked

INVESTIGATION FINDINGS:

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On 9/9/26, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator.
LPA conducted a physical plant inspection of the room previously occupied by R1.
LPA is unable to find and or meet the preponderance, per policy.
LPA observed the resident rooms to appear to have doors that lock from the outside and child proof handles are on the doorknobs in the hallway side. LPA found that the locking mechanism has been disabled to R1's room. The doors cannot be locked as alleged. The childproof handles still allow for residents to open their doors while discouraging a wandering resident from accessing others rooms.
As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview with administrator. Due to computer technical issues, report emailed for signature.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3