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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002795
Report Date: 08/06/2025
Date Signed: 08/06/2025 02:57:17 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
07/30/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250730144336
FACILITY NAME:RAI ANGELS LLCFACILITY NUMBER:
315002795
ADMINISTRATOR:RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:1422 ORWELL DR.TELEPHONE:
(360) 560-1818
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Balwinder Rai, Administrator TIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure that facility license number is included in advertisement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Balwinder Rai to open the complaint for the above complaint allegation.

During the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Licensee does not ensure that facility license number is included in advertisement
Observations of advertisements provided at the facility indicate that the facility license number is on all advertisements except the administrator business cards. Therefore, the allegation licensee does not ensure that facility license number is included in advertisements is substantiated.
Exit interview conducted. Appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
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 2
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
07/30/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250730144336

FACILITY NAME:RAI ANGELS LLCFACILITY NUMBER:
315002795
ADMINISTRATOR:RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:1422 ORWELL DR.TELEPHONE:
(360) 560-1818
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Balwinder Rai, Administrator TIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not allow resident to receive phone calls at the facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Balwinder Rai to open the complaint for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Licensee does not allow resident to receive phone calls at the facility
Interviews conducted indicate that Resident R1 is able to receive phone calls at the facility. R1 is under a conservatorship and calls must be approved through the conservator according to the court order. Facility staff are aware of the order in place and are abiding by the order. Records reviewed indicate that staff are following the court order and conservator regarding phone calls received at the facility. Therefore the allegation licensee does not allow resident to receive phone calls at the facility is unfounded.
Exit interview conducted.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2