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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315003016
Report Date: 05/12/2025
Date Signed: 05/12/2025 03:03:22 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
10/07/2024 and conducted by Evaluator Graham Gunby
COMPLAINT CONTROL NUMBER: 59-AS-20241007123249
FACILITY NAME:SENIOR CARE VILLA OF LOOMISFACILITY NUMBER:
315003016
ADMINISTRATOR:ILONA CORPUSFACILITY TYPE:
740
ADDRESS:3400 CHISOM TRAILTELEPHONE:
(916) 652-8000
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY:35CENSUS: 27DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Resident Care Coordinator - Christina BrownTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff cut resident’s hair without consent from authorized representative.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 05/12/2025 to complete and deliver findings to a complaint received on 10/07/2024. LPAs met with Executive Director, Ilona Corpus and explained the purpose of the visit.

Throughout the course of the investigation, the department conducted interviews and record reviews.

Please continue to LIC9099C..

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
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 6
Control Number 59-AS-20241007123249
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: SENIOR CARE VILLA OF LOOMIS
FACILITY NUMBER: 315003016
VISIT DATE: 05/12/2025
NARRATIVE
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Staff cut resident’s hair without consent from authorized representative. – Substantiated

Staff cut R1’s hair without obtaining prior consent from the authorized representative, which is a violation of the R1’s personal rights. However, there is no evidence that the resident sustained any physical or emotional harm. Based on staff and resident interviews the investigation revealed that the facility provides routine haircuts to male residents every three to five weeks as part of grooming and hygiene care. According to the Executive Director (ED), Resident 1 (R1) typically does not request a haircut, and in this case, a caregiver independently decided to cut R1’s hair, citing hygiene concerns due to the residents at the time. The caregiver did not obtain prior consent from R1’s authorized representative. Although the facility stated that routine haircuts are standard practice, staff failed to obtain consent from R1’s authorized representative prior to the haircut, which is required. There was no indication that R1 experienced emotional distress, physical injury, or any other form of harm as a result of the haircut.

As a result of this investigation, LPA finds allegations to be Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 59-AS-20241007123249
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: SENIOR CARE VILLA OF LOOMIS
FACILITY NUMBER: 315003016
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2025
Section Cited
CCR
87468(a)(1)
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87468.1 (a) (1) Personal Rights of Residents in All Facilities:(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons.
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 Facility agrees to obtain prior consent from authorized representatives before providing grooming services, including haircuts. The facility will include this document in their admission agreement.
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This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, facility did not confirm with responsible party to cut the residents hair.
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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: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
10/07/2024 and conducted by Evaluator Graham Gunby
COMPLAINT CONTROL NUMBER: 59-AS-20241007123249

FACILITY NAME:SENIOR CARE VILLA OF LOOMISFACILITY NUMBER:
315003016
ADMINISTRATOR:ILONA CORPUSFACILITY TYPE:
740
ADDRESS:3400 CHISOM TRAILTELEPHONE:
(916) 652-8000
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY:35CENSUS: 27DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Resident Care Coordinator - Christina BrownTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff does not ensure call button is accessible to resident.
Staff not keeping an accurate medication log.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Graham Gunby arrived unannounced on 05/12/2025 to complete and deliver findings to a complaint received on 10/07/2024. LPAs met with Executive Director, Ilona Corpus and explained the purpose of the visit.

Throughout the course of the investigation, the department conducted interviews and record reviews.

Please continue to LIC9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 59-AS-20241007123249
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: SENIOR CARE VILLA OF LOOMIS
FACILITY NUMBER: 315003016
VISIT DATE: 05/12/2025
NARRATIVE
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Staff does not ensure call button is accessible to resident. – Unsubstantiated

During staff interviews, staff reported each client has a pull cord at bedside and in each bathroom.

Based on investigation, LPA Gunby observed each resident room has a pull cord on the wall by resident bed and one in each resident bathroom. LPA Gunby observed a R1’s room with a pull cord attached to the wall with a longer cord for easier access to pull. LPA Gunby requested call button logs and observed only several residents using the call buttons.

Based on the investigation, observations and interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

Staff not keeping an accurate medication log. – Unsubstantiated

During the initial visit and walk through, the medications were reviewed, and it was noted that the facility staff were logging all new and current incoming medications and prescriptions. It was also observed in the medications log that the staff were checking off that they are giving the resident their medication. The ED stated that if they were to dispose of medication for a resident, that there would be two staff persons that would witness the disposal and that the two staff persons would sign and log that they did dispose of the medication.

Based on the investigation, observations and interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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
10/07/2024 and conducted by Evaluator Graham Gunby
COMPLAINT CONTROL NUMBER: 59-AS-20241007123249

FACILITY NAME:SENIOR CARE VILLA OF LOOMISFACILITY NUMBER:
315003016
ADMINISTRATOR:ILONA CORPUSFACILITY TYPE:
740
ADDRESS:3400 CHISOM TRAILTELEPHONE:
(916) 652-8000
CITY:LOOMISSTATE: CAZIP CODE:
95650
CAPACITY:35CENSUS: 27DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Resident Care Coordinator - Christina BrownTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Staff does not properly prepare resident’s meals.
INVESTIGATION FINDINGS:
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Interview with staff member indicated that dietary restrictions are sent to kitchen from Medical Technicians based on doctor’s orders. Dietary restrictions are posted in the kitchen. Kitchen staff prepare food according to dietary restrictions. Staff know the dietary restrictions of the residents they are serving as well. LPA Gunby observed dietary restrictions list and meal plans for the residents, posted in the kitchen.

Based on interviews and observations, the allegation about is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 6