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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002096
Report Date: 09/17/2025
Date Signed: 09/17/2025 03:31:04 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
09/16/2025 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250916084932
FACILITY NAME:LOOMIS HOME CAREFACILITY NUMBER:
315002096
ADMINISTRATOR:MILE, PETREFACILITY TYPE:
740
ADDRESS:7964 RASMUSSEN RD.TELEPHONE:
(916) 705-3318
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY:6CENSUS: 1DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Petre MileTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not treat resident with dignity/respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Wednesday September 17, 2025 to conduct a visit regarding a complaint received on 9/16/2025. LPA met with Administrator Peter and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed the Administrator and staff regarding the allegation. LPA reviewed R1's facility file. LPA learned the following: R1 moved into the facility in May 2025. On September 14, 2025, R1 requested for the Administrator to give them a pill to die. The Administrator explained that he will reach out to R1's primary physician for psychiatry referral the following day (Monday). Then R1 stated 'why do you hate me'. The Administrator explained that he does not hate them, but now it is time for their routine toileting.R1 declined. The Administrator then attempted to give R1 a glass of water and take their dinner plate, at which time, R1 scratched the Administrator's arm. The Administrator became upset and used derogatory language towards R1. R1 then asked for the phone from the staff. R1 then called their family and then 911. While waiting for 911, the Administrator called an advise line for R1's healthcare, who then instructed for the Administrator to send R1 to the hospital for testing.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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-20250916084932
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: LOOMIS HOME CARE
FACILITY NUMBER: 315002096
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities . . . (1) To be accorded dignity in their personal relationships with staff. . .This requirement was not met as evidenced by
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Facility agrees to do the following: The Administrator submitted a statement of understanding during the visit.
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interview with the Administrator. This poses an indirect threat to the health and safety of 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: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250916084932
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: LOOMIS HOME CARE
FACILITY NUMBER: 315002096
VISIT DATE: 09/17/2025
NARRATIVE
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 Once the police and paramedics arrived, R1 was taken to the hospital and later diagnosed with a UTI.

Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Appeal rights were given.

Exit interview conducted. A copy of this report was left with the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3