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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700722
Report Date: 08/05/2025
Date Signed: 08/05/2025 02:11:22 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
02/19/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250219125916
FACILITY NAME:WELLQUEST OF ELK GROVEFACILITY NUMBER:
342700722
ADMINISTRATOR:ELENA CUEVASFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(916) 689-1000
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: 108DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Elena Cuevas TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff did not ensure that resident was administered their medication(s) as prescribed.
INVESTIGATION FINDINGS:
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On 08/05/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Elena Cuevas and explained the purpose of the visit.
The purpose of this visit was to deliver complaint findings for the allegation above.
Current census was 108. A brief interview with FDA Cuevas was conducted.
It was alleged that facility staff did not ensure that the resident was administered their medication as prescribed. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted it was learned from facility staff that R1 missed their medication on 02/04/2025 because there was an issue with ordering R1's medication within the month of January 2025. It stated that once the medication was ordered from the pharmacy, the pharmacy was unable to get a hold of the doctor to renew the prescription order. However, it was admitted that the facility staff did not follow up as needed to ensure that the medication was available for the next month, therefore missing their medication for 02/04/2025.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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
Control Number 27-AS-20250219125916
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: WELLQUEST OF ELK GROVE
FACILITY NUMBER: 342700722
VISIT DATE: 08/05/2025
NARRATIVE
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A review of the medication administration record for this period reflects the missed medication for 02/04/2025 due to missing medication.
Based on the information gathered, the facility staff did not ensure that the resident was administered their medication(s) as prescribed.
As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.
The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.
An Exit Interview was conducted and a copy of this report was provided to the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 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
02/19/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250219125916

FACILITY NAME:WELLQUEST OF ELK GROVEFACILITY NUMBER:
342700722
ADMINISTRATOR:ELENA CUEVASFACILITY TYPE:
740
ADDRESS:8871 E STOCKTON BLVDTELEPHONE:
(916) 689-1000
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:170CENSUS: 108DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Elena Cuevas TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Facility staff do not respond to call bell in a timely manner.
INVESTIGATION FINDINGS:
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On 08/05/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Elena Cuevas and explained the purpose of the visit.
The purpose of this visit was to deliver complaint findings for the allegation above.

Current census was 108. A brief interview with FDA Cuevas was conducted.

It was alleged that the facility staff did not respond to call bell in a timely manner. During the course of this investigation. The department conducted interviews and reviewed facility records. Based on interviews conducted with staff it was denied that facility staff did not respond to call bell in a timely manner. It was stated by staff that call bells are responded to within 5 to 10 minutes. An interview with 5 residents were conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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-20250219125916
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: WELLQUEST OF ELK GROVE
FACILITY NUMBER: 342700722
VISIT DATE: 08/05/2025
NARRATIVE
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An interview with 5 residents were conducted. 5 out 5 residents state that they do not have any issues when pressing their call bells for assistance. A review of the facility call button log shows an average response time of 9-11 minutes between the months of January-Febuary 2025. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time.
An exit interview was conducted and a copy of this report were provided to the facility at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250219125916
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: WELLQUEST OF ELK GROVE
FACILITY NUMBER: 342700722
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2025
Section Cited
CCR
87465(a)(4)
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(4) The licensee shall assist residents with self-administered medications as needed.
This is not met as evidenced by:
The licensee did not ensure that they assisted R1 with their medication.
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The administrator states that a statement of correction has been conducted. A copy of this statement will be provided to the LPA by POC date.
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The licensee did not obtain medication as prescribed resulting in a missed dosage. This poses a potential health, safety, and personal rights risks to persons 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: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5