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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700731
Report Date: 07/02/2025
Date Signed: 07/02/2025 01:39:55 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
05/07/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250507140403
FACILITY NAME:LOVE AND COMFORT ELDERLY CAREFACILITY NUMBER:
342700731
ADMINISTRATOR:CLEOPATRA GARDINERFACILITY TYPE:
740
ADDRESS:6532 RANCHO GRANDE WAYTELEPHONE:
(916) 594-9378
CITY:SACRAMNETOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 5DATE:
07/02/2025
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Facility Staff: Aisake RatuTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility EXITS are not adequately marked
Staff isolate residents in their rooms
Staff did not provide assistant to resident in a timely manner
INVESTIGATION FINDINGS:
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On 7/2/2025 at 11:30 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with care staff Aisake Ratu and explained the purpose of the visit. Aisake called the facility designated administrator to inform that CCLD was present in the facility.The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 5. A brief interview with conducted with Aisake Ratu.

Allegation: Facility EXITS are not adequately marked
It was alleged that facility exits are not adequately marked. This investigation consisted of facility observation. On 5/15/2025 LPA Pang Lee conducted a facility visit, during a walkthrough of the facility, it was noted that three exit signs posted by the entry door, sliding door in the common area and the door in the dining area leading to the hallway.
Continuation 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
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-20250507140403
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: LOVE AND COMFORT ELDERLY CARE
FACILITY NUMBER: 342700731
VISIT DATE: 07/02/2025
NARRATIVE
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On 7/2/2025 LPA Hughes conducted a follow-up facility visit, during facility observation EXIT signage located on the fire door was observed and properly labeled as an Exit, Fire door remained closed.
Based on the information obtained, there is no evidence to support the allegation, therefore it could not be corroborated at this time.

Allegation: Staff isolate residents in their rooms
It was alleged that staff isolate residents in their rooms. This investigation consisted of facility observation, and interview with residents. On 5/15/2025 LPA Pang Lee conducted a facility visit, residents in care were freely moving in and out of their rooms and engaging in interactions outside their rooms. On 7/2/2025 interviews with 2 out of 2 residents indicated that residents have no concern with staff isolating residents in their rooms. LPA Hughes observed 2 additional residents watching television outside of their rooms in the common area. Based on the information obtained, there is no evidence to support the allegation, therefore it could not be corroborated at this time.

Allegation: Staff did not provide assistant to resident in a timely manner
It was alleged that staff did not provide assistant to resident in a timely manner. This investigation consisted of facility observations, and interviews with residents. On 5/15/2025 LPA Pang Lee conducted a facility visit, and observation during the visit reflected that facility care staff were actively engaged in assisting residents with medication administration, showering, and preparing meals. On 6/17/2025 LPA Shakaricka Hughes, conducted a follow-up facility visit, and observed facility staff assisting residents with preparing lunch, and duties that included care needs of the residents within resident bedrooms. Resident interviews indicated that residents have no concerns with facility staff not being able to assist residents in a timely manner. Based on the information obtained, there is no evidence to support the allegation, therefore it could not be corroborated at this time.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations 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 violations occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
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
05/07/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250507140403

FACILITY NAME:LOVE AND COMFORT ELDERLY CAREFACILITY NUMBER:
342700731
ADMINISTRATOR:CLEOPATRA GARDINERFACILITY TYPE:
740
ADDRESS:6532 RANCHO GRANDE WAYTELEPHONE:
(916) 594-9378
CITY:SACRAMNETOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 5DATE:
07/02/2025
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Facility Staff: Aisake RatuTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not treat residents with dignity and respect
INVESTIGATION FINDINGS:
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On 7/2/2025 at 11:30 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with Aisake Ratu 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. A brief interview with conducted with Aisake Ratu.

Allegation: Staff did not treat residents with dignity and respect
It was alleged that staff did not treat resident with dignity and respect. This investigation consisted of interview with residents. On 5/15/2025 LPA Pang Lee conducted a facility visit, during resident interviews 3 out of 5 residents stated that they observed incidents in which a staff member allegedly threw water on Resident (R4) face by staff. On 6/17/2025 LPA Shakaricka Hughes, conducted a follow-up facility visit, during resident interview with Resident (R4) it was revealed that facility staff throws water on R4’s face.

Continuation 809-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
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-20250507140403
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: LOVE AND COMFORT ELDERLY CARE
FACILITY NUMBER: 342700731
VISIT DATE: 07/02/2025
NARRATIVE
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This allegation was observed not in compliance with Title 22 regulation 87468.1(a)(1) as residents in the facility are to accorded dignity in their personal relationships with staff, residents, and other persons. As a result, this allegation is substantiated.

As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Aisake Ratu and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.
 
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250507140403
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: LOVE AND COMFORT ELDERLY CARE
FACILITY NUMBER: 342700731
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/04/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1 Personal Rights for Residents in all Facilities.(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff...This requirement was not met as evidenced by:
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Licensee will ensure that residents in care will be treated with dignity and respect. Licensee will review Title 22 regulation 87468.1(a)(1) and write a statement of understanding. Licensee will provide facility staff with adequate trainings related to residents
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Licensee failed to ensure that resident in care was treated with dignity and respect. Facility staff used a turkey baster to squirt water on the eyes of a resident in care.
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Personal Rights to LPA Shakaricka Hughes by 7/4/2025.
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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: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5