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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700594
Report Date: 02/12/2026
Date Signed: 02/12/2026 12:17:07 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
11/20/2025 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251120083206
FACILITY NAME:WOODLAKE, THEFACILITY NUMBER:
342700594
ADMINISTRATOR:PETER BLANCHARDFACILITY TYPE:
740
ADDRESS:1445 EXPO PARKWAYTELEPHONE:
(916) 604-3780
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:0CENSUS: 0DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Latrice Ross TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Refund was not issued in a timely manner
Resident's incontinence care needs were not met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced complaint inspection with the above facility on Feburary 12, 2026, at 11:45 AM, and met with Latrice Ross (Administrator). The purpose of the inspection was to deliver complaint findings for the above allegations.

Confidential interviews were conducted with eleven individuals during the period of November 25, 2025, to Feburary 12, 2026.

Based on interviews conducted and records reviewed, resident 1 (R1) belongings were moved out of the facility on June 14, 2025. The responsible party (RP) recieved a refund on August 15, 2025. Staff 1 (S1) also indicated the RP did not receive their refund in a timely manner. As a result, it was determined the facility did not issue a refund within fifteen days to the RP.

Continued...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 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
11/20/2025 and conducted by Evaluator Avelina Martinez
COMPLAINT CONTROL NUMBER: 27-AS-20251120083206

FACILITY NAME:WOODLAKE, THEFACILITY NUMBER:
342700594
ADMINISTRATOR:PETER BLANCHARDFACILITY TYPE:
740
ADDRESS:1445 EXPO PARKWAYTELEPHONE:
(916) 604-3780
CITY:SACRAMENTOSTATE: CAZIP CODE:
95815
CAPACITY:0CENSUS: 0DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Latrice RossTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Itemized list of charges was not provided to resident's representative.
Staff did not notify resident's responsible party of change in condition.
Facility was understaffed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced complaint inspection with the above facility on Feburary 12, 2026, at 11:45 AM and met with Latrice Ross (Administrator). The purpose of the inspection was to deliver complaint findings for the above allegations.

Confidential interviews were conducted with ten individuals during the period of November 25, 2025, to Feburary 12, 2026.

LPA Martinez reviewed email between facility staff and witness 1 (W1). Emails indicate facility staff was communicating with W1 regarding requested itemized list. W1's November 15, 2025 email requested an itemized list, and facility staff emailed W1 an itemized list on November 24, 2025. The email also indicated if W1 had any questions to reach out. This email thread ended on November 24, 2025.

Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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 5
Control Number 27-AS-20251120083206
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: WOODLAKE, THE
FACILITY NUMBER: 342700594
VISIT DATE: 02/12/2026
NARRATIVE
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There is no other documentation that show the facility stopped responding to W1's itemized bill report request, or that W1 reached out after the November 24, 2025 email to request additional Itemized bill reports. Therefore, there is not sufficient evidence to corroborate that the facility did not provide W1 an Itemized bill report.

LPA Martinez reviewed R1's Negotiated Service Agreement, which was signed by W1 on May 15, 2025. The Negotiated Service Agreement indicates facility staff will report any concern to the hospice agency and to R1's primary care physician. During records reviews, it was learned that facility staff reported R1's health concerns to W1. Three out of five staff members reported they informed W1 of R1' health care changes. Due to the information obtained, during the investigation, there is not sufficient evidence to corroborate that the facility did not notify R1's responsible party of a change in condition.

LPA Martinez interviewed five care staff members. Five out of five care staff members indicated they were not short staffed in June of 2025. LPA Martinez interviewed four residents. Two out of four residents indicated more staff is needed. Two out of four residents reported they had no staffing concerns. LPA Martinez reviewed June 2025 work schedule, which indicated that care staff shifts were covered.

Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20251120083206
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: WOODLAKE, THE
FACILITY NUMBER: 342700594
VISIT DATE: 02/12/2026
NARRATIVE
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LPA Martinez reviewed incontinent care records. After reviewing the incontinent care records, It was determined false incontinent care claims were documented. It was learned that facility staff members signed off on incontinent tasks that were not provided to R1. As a result, the obtained incontinent care records are misleading, and there is no other evidence to show that Incontinent care was being provided to R1.

As a result of this investigation, the Department finds these allegations to be Substantiated. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D page, per Title 22 Regulations. An exit interview was conducted, and a copy of this LIC 9099 report, LIC 9099-D page, and LIC appeal rights document were provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 27-AS-20251120083206
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: WOODLAKE, THE
FACILITY NUMBER: 342700594
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2026
Section Cited
CCR
87464(f)(1)
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87464(f)(1) Basic Services: Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: based on
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There will be no plan of correction, due to the fact that this facility license has been closed
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interviews and file reviews, the Licensee did not ensure R1 was being provided incontinent care as stated on their care plan. This posed a potential health and safety risk to R1.
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Type B
02/26/2026
Section Cited
HSC
1569.652(c)
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1569.652(c)Termination of admission agreement ... refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the...entity contractually responsible for the
fees...within 15 days after the personal
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There will be no plan of correction, due to the fact that this facility license has been closed
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property is removed. This requirement was not met as evidence by: based on interviews and file reviews, the Licensee did not ensure to provide a refund to R1's RP in a timely manner. This posed a potential health and safety 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: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5