342700012-4-11-2025-59-AS-KHOS-DFSJD8-20250416065708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700012
Report Date: 04/11/2025
Date Signed: 04/11/2025 01:17:49 PM

Unfounded

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
04/01/2025 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20250401103006

FACILITY NAME:	TWIN RIVERS AT NATOMAS		FACILITY NUMBER:	342700012
ADMINISTRATOR:	GENAYA REESE		FACILITY TYPE:	740
ADDRESS:	421 SAN JUAN ROAD		TELEPHONE:	(916) 216-3058
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95834
CAPACITY:	48	CENSUS: 37	DATE:	04/11/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Rosa Lesui and Emonnie Rowe		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Due to lack of supervision, resident assaulted another resident

INVESTIGATION FINDINGS:

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On April 11, 2025, Licensing Program Analsyt (LPA) Cassie Yang arrived unannounced at the facility to investigate the allegation of the complaint listed above. LPA met with medication technican and Assistant Administrator and explained the purpose of the visit.

Today's investigation, LPA conducted extensive file reviews and interviews.

Result of investigation is as follow on LIC 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

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

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20250401103006

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: TWIN RIVERS AT NATOMAS	FACILITY NUMBER: 342700012
	VISIT DATE: 04/11/2025

NARRATIVE

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LIC 9099-C

Allegation: Due to lack of supervision, resident assaulted another resident.

The Department conducted interviews and file reviews. Based on file review of R1's care plan revealed R1 calls ombudsman for issues and needs outlet for complaints. R1's medical assessment indicated R1 is non-ambulatory physically and mentally with active problem of schizo affective disorder. File review of communication log revealed on March 26, 2025 R1 was observed to have a large upper arm bruising and will be going to the emergency room for evaluation. File review revealed on March 28, 2025 was when the alleged altercation occurred which R1 reported to S1. Interview conducted with S1 revealed S1 conducted an investigation and found that R2 "touched" R1's hand but did not hit R1. S1 stated R1 was satisfied with the response. On March 29, 2025, R1 then went to the emergency room to evaluate further new bruising on R1's chest area. Interview conducted with Assistant Administrator revealed there are at least two caregivers and one medication technican for AM and PM shift, and one staff for NOC shift. Assistant Administrator stated R1 takes Warfarin which causes usual bruises, R1 has the tendency of not fully speaking the truth as R1 has the diagnosis of schizo affective disorder. Interview with Assistant Administrator revealed R2 does not have a history of physical aggression to staff and residents in care.

Based on information obtained, the allegation listed above is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of the report was provided.

SUPERVISOR'S NAME: Anthony Perez	TELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie Yang	TELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025

LIC9099 (FAS) - (06/04)

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