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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700588
Report Date: 02/20/2026
Date Signed: 02/20/2026 12:51:56 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
01/20/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260120092359
FACILITY NAME:SIGNATURE LIVING ON WINDING WAYFACILITY NUMBER:
342700588
ADMINISTRATOR:AFABLE, SCOTTFACILITY TYPE:
740
ADDRESS:6258 WINDING WAYTELEPHONE:
(916) 812-0944
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
02/20/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Placida Devera, AdministratorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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-Staff restraining resident in a room.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Placida Devera, to deliver complaint investigation findings regarding the above stated allegation.
On January 28, 2026, LPA observed that the doorknob on resident (R1's) door had a lock on the outside of the door. LPA also observed that R1's window had a nail in it preventing the window from opening. Interviews with the Administrator and staff (S1) indicated that R1 removes the door alarms and is exit seeking. Interviews also indicated that locking R1 in their room at night was due to safety concerns from R1's exit seeking behaviors. During the visit, the Administrator and S1 removed the nail in the window and changed the doorknob on the door to a knob without a lock. On February 20, 2026, LPA was informed that R1 has moved out of the care home.
Based on observations and interviews conducted, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiency is being cited on the attached 9099-D page.
Exit interview conducted. A copy of the report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
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 3
Control Number 59-AS-20260120092359
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: SIGNATURE LIVING ON WINDING WAY
FACILITY NUMBER: 342700588
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2026
Section Cited
CCR
87468.2(a)(8)
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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, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from...involuntary seclusion...
This requirement is not met as evidenced by:
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Licensee shall create a plan for exit seeking behaviors and submit to LPA by the POC due date of 2/23/26.
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Based on observations and interviews conducted, the facility did not ensure resident (R1) was free of involuntary seclusion, which poses an immediate health, safety, and personal rights risk to 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: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
01/20/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260120092359

FACILITY NAME:SIGNATURE LIVING ON WINDING WAYFACILITY NUMBER:
342700588
ADMINISTRATOR:AFABLE, SCOTTFACILITY TYPE:
740
ADDRESS:6258 WINDING WAYTELEPHONE:
(916) 812-0944
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
02/20/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Placida Devera, AdministratorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Staff yells at residents.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
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9
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13
Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Placida Devera, to deliver complaint investigation findings regarding the above stated allegation.

Interviews with the Administrator and staff (S1) indicated that they have never witnessed staff yelling at residents in care. Interviews with residents (R2, R3, R4, R5, and R6) indicated that they have never experienced or witnessed staff yelling at residents. Interviews with residents also indicated that staff treat them well.

Based on interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited. Exit interview conducted. A copy of the report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3