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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920252
Report Date: 06/22/2026
Date Signed: 06/29/2026 02:32:33 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
01/23/2026 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260123132315
FACILITY NAME:REVIVAL SENIOR LIVING, LLCFACILITY NUMBER:
315920252
ADMINISTRATOR:PALAMARCHUK, RICHARDFACILITY TYPE:
740
ADDRESS:3755 MOUNTAIN VIEW DRIVETELEPHONE:
(909) 333-8287
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 0DATE:
06/22/2026
UNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Jonathan GallegosTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Residents personal items were not safeguarded
INVESTIGATION FINDINGS:
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An office meeting was held on Monday June 29, 2026 to deliver findings for a complaint which was received by the Department on 1/23/2026. Present was Regional Manager Harpreet Humpal, Licensing Program Manager Laura Munoz, Licensing Program Analyst Melissa Parks, and Licensee Jonathan Gallegos.

Throughout the course of the investigation, LPA interviewed the management, staff, and residents regarding the allegations. LPA learned the following:
Residents personal items were not safeguarded
R1 and R2 moved out of the facility in January 2026. R1 and R2’s responsible party noticed that several personal items were missing. R2 was missing several personal items including a watch, ring, and cell phone. R1 was also missing a cell phone. S1 stated during an interview that facility staff confiscated the cell phones because R2 was consistently calling 911. S1 stated that the phones were secured at the facility and were not given back when R1 and R2 vacated the facility. Licensee Gallegos emailed LPA Parks on 1/30/2026 stated that he mailed the phones to R1 and R2’s responsible party.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2026
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-20260123132315
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: REVIVAL SENIOR LIVING, LLC
FACILITY NUMBER: 315920252
VISIT DATE: 06/22/2026
NARRATIVE
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Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D.

Exit interview. Copy of report and appeal rights provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Citations on this Visit Report are Under Appeal!

Control Number 59-AS-20260123132315
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: REVIVAL SENIOR LIVING, LLC
FACILITY NUMBER: 315920252
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
07/13/2026
Section Cited
CCR
87468.2(a)(27)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities,
(27) To keep, have access to, and use their own personal possessions, including toilet articles, and to keep and be allowed to spend their own money, unless limited by statute or regulation.
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The licensee agrees to submit a statement of understanding regarding resident rights.
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This requirement was not met as evidencd by R1 and R2's cell phones were confiscated and secured by the facility. This poses an indirect threat to the health and safety of residents in care.
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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: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 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
01/23/2026 and conducted by Evaluator Melissa Parks
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20260123132315

FACILITY NAME:REVIVAL SENIOR LIVING, LLCFACILITY NUMBER:
315920252
ADMINISTRATOR:PALAMARCHUK, RICHARDFACILITY TYPE:
740
ADDRESS:3755 MOUNTAIN VIEW DRIVETELEPHONE:
(909) 333-8287
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 0DATE:
06/22/2026
UNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Jonathan GallegosTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff had unprofessional relationship with residents
Facility attempted to interfere with resident's personal rights
INVESTIGATION FINDINGS:
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An office meeting was held on Monday June 29, 2026 to deliver findings for a complaint which was received by the Department on 1/23/2026. Present was Regional Manager Harpreet Humpal, Licensing Program Manager Laura Munoz, Licensing Program Analyst Melissa Parks, and Licensee Jonathan Gallegos.

Interviews were conducted with residents and staff. No disclosures were made that staff are unprofessional with residents or attempt to interfere with residents’ rights.

Based on information obtained during the investigation, LPA finds the allegations to be
UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred

Exit interview conducted. A copy of this report was provided to the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2026
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 4