<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317000989
Report Date: 04/15/2025
Date Signed: 04/15/2025 11:11:28 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
03/04/2025 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250304134437
FACILITY NAME:ROSEVILLE ADULT CENTERFACILITY NUMBER:
317000989
ADMINISTRATOR:DEVON MARTINEZFACILITY TYPE:
775
ADDRESS:531 VERNON STREETTELEPHONE:
(916) 783-5700
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:75CENSUS: 43DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Devon MartinezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate supervision to client in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 On April 15, 2025,, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Administrator
LPA conducted records review and interviews.
LPA is unable to find and or meet the preponderance, per policy.
On 1/28/25, R1 was attending day program. R1 stayed back from a group outing to a nearby library. When engaed with staff at the program, R1 went toward the facility bathroom. When R1 did not return, S1 checked on them and found that R1 was no longer in the building. A search was conducted and R1 was found to have walked to the library. R1 retured safely.
Records and interviews found that AWOLing was not a previously identified behavior for R1 though it was a known behavior to R1's responsible party. As the behavior was not previously identified, staffing was within ratio and program policy prohibits enrollment if clients are AWOL risks, the program provided appropriate supervision for known client needs.
As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint 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 with administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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 1