342700683-1-8-2026-27-AS-CACL-DQJLEA-20260121074113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700683
Report Date: 01/08/2026
Date Signed: 01/08/2026 02:51:52 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
09/30/2025 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20250930163954

FACILITY NAME:	ACC MAPLE TREE VILLAGE		FACILITY NUMBER:	342700683
ADMINISTRATOR:	YESENIA JONES		FACILITY TYPE:	740
ADDRESS:	18 KADO CT		TELEPHONE:	(916) 395-7579
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95831
CAPACITY:	125	CENSUS: 86	DATE:	01/08/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Yesenia Jones		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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1) Licensee does not ensure facility is maintained in good repair.
2) Staff do not ensure that residents are adequately fed while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to the ACC Maple Tree Village RCFE on 1/8/26 at 9:15am to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with Administrator, Yesenia Jones and together discussed the investigation details.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA Gould conducted interview with eights (8) residents, two (2) family members and two (2) staff members. Of the residents interviewed seven of the eight residents denied the facility ever running out of food during meals.

Report continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

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 27-AS-20250930163954

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: ACC MAPLE TREE VILLAGE	FACILITY NUMBER: 342700683
	VISIT DATE: 01/08/2026

NARRATIVE

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One resident interviewed provided statements that the facility ran out of one main course but the facility had alternative food options such as a second main course prepared daily and an alternative menu offered daily including hot and cold sandwiches, salads and other options available at lunch or dinner. Staff members interviewed denied ever running out of food to serve residents. LPA reached out to and conducted interview with co-complainant but could not verify their allegations. LPA also conducted kitchen walk through, observed fridge temperatures and observed documented readings of fridge temperatures that corresponded with LPA observations.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Physical Plant and Food Services are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies is cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC9099 (FAS) - (06/04)

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