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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 03:06:05 PM

Unsubstantiated


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
11/20/2024 and conducted by Evaluator Graham Gunby
COMPLAINT CONTROL NUMBER: 59-AS-20241120142205
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 Director - Christina BrownTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Resident developed a pressure injury due to staff not repositioning resident
Facility staff left resident in soiled clothing for an extended period of time
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. LPA met with Resident Care Coordinator Christina Brown 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: 1 of 2
Control Number 59-AS-20241120142205
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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Resident developed a pressure injury due to staff not repositioning resident. – Unsubstantiated

The Department received and reviewed R1’s medical records. The medical records indicated there were not pressure injuries present on R1. Throughout interviews with staff and medical record reviews, it was determined R1 had irritation and redness on the coccyx area. The facility provided documentation acknowledging that R1 primary stayed in bed or a wheelchair and would need to be repositioned frequently. With repositioning’s often and application of cream to the area, the facility and hospice were aware of the affected areas.

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.

Facility staff left resident in soiled clothing for an extended period of time. – Unsubstantiated

The complaint alleges facility staff did not address R1 being left in soiled clothing in a timely manner. Based on interviews that were conducted, LPA could not prove or disprove that the allegation occurred. LPA received consistent statements, that residents are checked every 2 hours throughout the day and night. LPA reviewed the Service Plan which indicated that the resident needed assistance with toileting and dressing. LPA could not corroborate the allegation.

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: 2 of 2