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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700381
Report Date: 07/06/2026
Date Signed: 07/06/2026 12:04:15 PM

Unsubstantiated


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
06/03/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260603102230
FACILITY NAME:SUPREME RESIDENTIAL CARE FACILITYFACILITY NUMBER:
342700381
ADMINISTRATOR:STEPHANIE M SIEWEFACILITY TYPE:
740
ADDRESS:8326 SUMMER CREEK CTTELEPHONE:
(916) 895-2787
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 5DATE:
07/06/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator: Stephanie SieweTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
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5
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9
Facility staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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5
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On 07/06/2026, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with Administrator Stephanie and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 5.

Allegation: Facility staff handled resident in a rough manner
It was alleged that facility staff handles a resident in a rough manner. This investigation consisted of interviews with facility staff and residents in care. On 06/12/2026 LPA Hughes conducted a visit to the facility and spoke with facility staff (S2) who denied ever handling any resident in a rough manner. LPA interviewed one (1) resident, who stated they have never been handled roughly by facility staff and had not observed other residents being handled in a rough manner. LPA also interviewed Resident (R1), who stated they had never been handled roughly by facility staff and reported having no concerns regarding the care provided by facility staff. Based on the information obtained there is not enough evidence or information available to corroborate this allegation, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2026
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 2
Control Number 27-AS-20260603102230
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: SUPREME RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 342700381
VISIT DATE: 07/06/2026
NARRATIVE
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The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2