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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002795
Report Date: 08/07/2025
Date Signed: 08/07/2025 01:06:07 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
07/28/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250728113144
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: 6DATE:
08/07/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Veniesha Gillum, CarestaffTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff did not allow a resident to leave the facility
Staff did not prevent a resident from using foul language towards another resident in care
Staff did not allow a resident to have a visitor
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Veniesha Gillum to deliver findings for the above complaint allegation. LPA spoke with Administrator Balwinder Rai via phone to deliver findings.

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:

*** Report continued on 9099-C***
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
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
Control Number 59-AS-20250728113144
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: RAI ANGELS LLC
FACILITY NUMBER: 315002795
VISIT DATE: 08/07/2025
NARRATIVE
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Staff did not allow a resident to leave the facility.

Interviews conducted indicated that Resident R1 is allowed to leave the facility with assistance. Interviews with resident R1 indicated that R1 is happy at the facility but does want move back home or with R1’s son. R1 is currently in the process of moving back home. Records reviewed indicate that R1 is able to leave and currently has a conservatorship in place to monitor when R1 is able to leave the facility. Therefore, the allegation staff did not allow a resident to leave the facility is unfounded.

Staff did not prevent a resident from using foul language towards another resident in care.

Interviews with staff indicated that none of the residents in care use foul language towards another resident in care. Staff monitor all residents during meal times and activities to ensure a calm community atmosphere. Interviews with residents in care indicated there has been no use of foul language from residents or staff. Therefore, the allegation staff did not prevent a resident from using foul language towards another resident in care is unfounded.

Staff did not allow a resident to have a visitor.

Interviews conducted with staff indicated that Resident R1 was allowed to have visitors at the facility. Documents reviewed indicated that facility visitor log was signed by visitors visiting R1 at the facility for different dates and times. Observations made indicated that visitors are allowed to enter the facility during visiting hours set by the facility and agreed upon within the admission agreement. Therefore, the allegation staff did not allow a resident to have a visitor is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2