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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700016
Report Date: 03/27/2025
Date Signed: 03/27/2025 04:01:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
03/25/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250325131228
FACILITY NAME:RESTPADD CARE LLCFACILITY NUMBER:
342700016
ADMINISTRATOR:NWANGBURUKA, IHEOMAFACILITY TYPE:
740
ADDRESS:6901 RIO TEJO WAYTELEPHONE:
(916) 685-3690
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 5DATE:
03/27/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Iheoma NwangburukaTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not providing proper notice of rate increases.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski met with facility administrator Iheoma Nwangburuka and explained the purpose of the visit.

LPA Moleski reviewed text message conversations between Nwangburuka and a resident's responsible party (R1's RP). On 3/15/25, Nwangburuka sent a text message to R1's RP raising their rates to $6500 per month, or $250 per day. According to Nwangburuka, prior to this, R1's RP was paying $5000 per month. The notice states that the increase was due to "significant changes in" R1's "health," and because R1 "is now receiving hospice care." Health and Safety Code Section 1569.657(a) requires that "for any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges." [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
03/25/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250325131228

FACILITY NAME:RESTPADD CARE LLCFACILITY NUMBER:
342700016
ADMINISTRATOR:NWANGBURUKA, IHEOMAFACILITY TYPE:
740
ADDRESS:6901 RIO TEJO WAYTELEPHONE:
(916) 685-3690
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:6CENSUS: 5DATE:
03/27/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Iheoma NwangburukaTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are charging fees without an updated admissions agreement.
Facility staff are not providing documents to a resident's attorney-in-fact as required.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski met with facility administrator Iheoma Nwangburuka and explained the purpose of the visit.

LPA Moleski reviewed text message conversations between Nwangburuka and a resident's responsible party (R1's RP). R1's RP had requested a copy of R1's admission agreement on 3/25/25 and had set a due date for 3/26/25. Nwangburuka responded the day the request was made and informed R1's RP that she would be able to get the admission agreement to R1's RP by the end of this week.

Although 22 CCR Section 87506(c)(1) requires that confidential records be made accessible to residents' responsible parties, no timelines for production of these records are provided. Nwangburuka's immediate response that she would get the admission agreement to R1's RP by the end of the week is reasonable.

[continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20250325131228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RESTPADD CARE LLC
FACILITY NUMBER: 342700016
VISIT DATE: 03/27/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA Moleski reviewed R1's file and observed an admission agreement which had been signed by R1's RP, dated 10/15/2017, shortly after a change of ownership took place at this facility.

The department has determined the following as it relates to the allegations that facility staff are charging fees without an updated admissions agreement and that facility staff are not providing documents to a resident's attorney-in-fact, as required.

Based on interviews and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited regarding the above allegations. An exit interview was held and a copy of this report was left with Nwangburuka.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20250325131228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: RESTPADD CARE LLC
FACILITY NUMBER: 342700016
VISIT DATE: 03/27/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In an interview, Nwangburuka said that the text message was the only form of written notification sent to R1's RP, although she did have two phone conversations discussing the increase with R1's RP on 3/16/25 and 3/22/25, respectively. The text message sent to R1's RP did not include a detailed explanation of the charges, and did not include an itemized list of charges, as required per Health and Safety Code Section 1569.657(a). Additionally, the notice was not sent within two business days after providing services at the new level of care. LPA Moleski reviewed a hospice notification form, and observed that R1 was placed on hospice as of 2/14/25.

LPA Moleski reviewed R1's file and observed an admission agreement which had been signed by R1's RP, dated 10/15/2017. The admission agreement identified R1's initial monthly rate as $3875. LPA Moleski asked Nwangburuka to provide written notices for previous increases from $3875 to the current rate of $5000. Nwangburuka was unable to immediately provide prior notices. LPA Moleski is requesting that Nwangburuka review her records and produce any and all prior written notices for any previous rate increases. Nwangburuka must also produce a formal written notice with all required information if she chooses to move forward with a rate increase due to R1's current level of care.

The department has determined the following as it relates to the allegation that facility staff are not providing proper notice of rate increases:

Based on interview and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

This facility is hereby cited per HSC Section 1569.657(a). An exit interview was held with Nwangburuka. Appeal rights and a copy of this report were left with Nwangburuka.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250325131228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: RESTPADD CARE LLC
FACILITY NUMBER: 342700016
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2025
Section Cited
HSC
1569.657(a)
1
2
3
4
5
6
7
"(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges." This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to provide LPA Moleski with an updated written notice regarding the rate increase containing all required details by POC due date. After approval, licensee shall provide this notice to R1's RP. Licensee agrees that this notice shall not backcharge R1's RP beyond the date served to R1's RP. Licensee further agrees to provide LPA Moleski with any and all written notices previously provided for any prior rate increases for R1.
vincent.moleski@dss.ca.gov
8
9
10
11
12
13
14
Based on record review, a written notice was provided regarding an increase in care costs, but which did not contain all required information per the above section, which poses a potential health, safety, and/or personal rights risk.
8
9
10
11
12
13
14
R1's RP shall continue paying their standard rate until licensee provides proper written notice.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5