315920040-10-15-2025-59-AS-LMUZ-DMNQ5K-20251021115203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 315920040
Report Date: 10/15/2025
Date Signed: 10/15/2025 10:54:34 AM

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
10/06/2025 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 59-AS-20251006095132

FACILITY NAME:	SIERRA RIDGE SENIOR LIVING		FACILITY NUMBER:	315920040
ADMINISTRATOR:	ALEXIS THACKER		FACILITY TYPE:	740
ADDRESS:	3265 BLUE OAKS DRIVE		TELEPHONE:	(530) 718-1553
CITY:	AUBURN	STATE: CA	ZIP CODE:	95602
CAPACITY:	65	CENSUS: 50	DATE:	10/15/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Tony Sellers		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff did not provide responsible party resident's records.

INVESTIGATION FINDINGS:

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Licensed Program Analyst (LPAs) Cassandra Mikkelson and Kerry Hiratsuka arrived at the facility unannounced and met with Tony Sellers to deliver findings for the above complaint allegations.

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***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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 4

Control Number 59-AS-20251006095132

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: SIERRA RIDGE SENIOR LIVING	FACILITY NUMBER: 315920040
	VISIT DATE: 10/15/2025

NARRATIVE

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Staff did not provide responsible party resident's records.
Interviews conducted with Administrator indicated that records that were requested were given to the responsible party on the day the resident moved out. It was a verbal request made by Resident R1’s responsible party to the Administrator who gave the documents prior to R1 leaving the building. Therefore, the allegation staff did not provide responsible party resident’s records is unsubstantiated.

Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
10/06/2025 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 59-AS-20251006095132

FACILITY NAME:	SIERRA RIDGE SENIOR LIVING		FACILITY NUMBER:	315920040
ADMINISTRATOR:	ALEXIS THACKER		FACILITY TYPE:	740
ADDRESS:	3265 BLUE OAKS DRIVE		TELEPHONE:	(530) 718-1553
CITY:	AUBURN	STATE: CA	ZIP CODE:	95602
CAPACITY:	65	CENSUS: 50	DATE:	10/15/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Tony Sellers		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff did not provide responsible party a refund in a timely manner
Staff did not provide responsible party with an itemized bill

INVESTIGATION FINDINGS:

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Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20251006095132

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: SIERRA RIDGE SENIOR LIVING	FACILITY NUMBER: 315920040
	VISIT DATE: 10/15/2025

NARRATIVE

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Staff did not provide responsible party a refund in a timely manner.

Interviews conducted indicated that there is a refund due to R1’s responsible party(RP). Facility has attempted on numerous occasions to reach out to R1’s RP to get an address to send the refund check to but have not received an answer from R1’s RP. Documents reviewed showed multiple attempts to collect an address from R1’s RP for the refund check. Therefore, the allegation staff did not provide responsible party a refund in a timely manner is unfounded.

Staff did not provide responsible party with an itemized bill.

Interviews conducted indicated that itemized bills are sent to each resident’s responsible party on a monthly basis. Records reviewed indicated that an itemized bill is sent to the responsible party on a monthly basis. Therefore, the allegation staff did not provide responsible party with an itemized bill 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: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

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