315002982-7-31-2025-59-AS-LMUZ-DK5LUD-20250801090347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315002982
Report Date: 07/31/2025
Date Signed: 07/31/2025 01:43:06 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
02/20/2025 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 59-AS-20250220114659

FACILITY NAME:	STONEBROOK LOVING HEARTS		FACILITY NUMBER:	315002982
ADMINISTRATOR:	DEMYAN, MICHAEL		FACILITY TYPE:	740
ADDRESS:	11585 STONEBROOK DR		TELEPHONE:	(916) 903-6459
CITY:	AUBURN	STATE: CA	ZIP CODE:	95603
CAPACITY:	6	CENSUS: 4	DATE:	07/31/2025
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Levi Magurean, Licensee		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Staff did not ensure adequate care and supervision was provided resulting in resident ingesting foreign objects

INVESTIGATION FINDINGS:

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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Licensee Levi Magurean to deliver findings 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:

*** Report continued on 9099-C***

Unfounded

Estimated Days of Completion: 14

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 709-6317
LICENSING EVALUATOR NAME: Cassandra Mikkelson	TELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20250220114659

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: STONEBROOK LOVING HEARTS	FACILITY NUMBER: 315002982
	VISIT DATE: 07/31/2025

NARRATIVE

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During the investigation, LPA interviewed staff, administrator, and Licensee regarding the above allegation. Interviews conducted indicated that resident R1 was completely immobile, unable to turn themselves in their own in bed and unable to reach for items. R1 was under the care of hospice and due to physical decline, R1 was bedridden. Interviews conducted with staff member (S1) indicated that they checked on R1 every fifteen to thirty minutes to ensure R1was comfortable. Interviews conducted with S1, Administrator and Licensee indicated that the staff are trained to take out the resident trash at least one time daily or immediately if any hazardous items are placed in the trash during care. S1 indicated they conducted body checks of R1, which included checking their mouth due to R1 no longer drinking fluids on their own and only getting fluids through a moistened sponge. S1 indicated nothing was ever found in R1’s mouth.

LPA toured the facility with Administrator and Licensee. LPA observed resident rooms were clean and all trash bins were empty for each room and out of reach of each resident’s bedside. LPA viewed all resident medications, cleaning products and hazardous items were locked away and inaccessible to residents in care.

LPA reviewed documentation that was pertinent to the investigation. Documents indicated that hospice was visiting R1 on a daily basis and documented visit notes from each visit. Documents also indicated the time and date R1 received medications for pain management from facility staff and hospice staff. Based on this information as well as LPA observing staff’s regular garbage removal, there is no evidence that multiple syringe caps could be found in the residents garbage pail.

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 with the Administrator. Copy of report was given to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 709-6317
LICENSING EVALUATOR NAME: Cassandra Mikkelson	TELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025

LIC9099 (FAS) - (06/04)

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