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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 03/13/2025
Date Signed: 03/13/2025 03:28:31 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
01/15/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250115102932
FACILITY NAME:CITY CREEK ASSISTED LIVINGFACILITY NUMBER:
342700835
ADMINISTRATOR:CALEB SUMMERHAYSFACILITY TYPE:
740
ADDRESS:6254 66TH AVENUETELEPHONE:
(916) 393-2324
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:121CENSUS: 113DATE:
03/13/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Katelyn FloresTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Facility staff does not ensure facility is kept in clean sanitary conditions at all times.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski and Administrative Assistant Nicholas Morisi arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with Health Services Director Katelyn Flores and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review. LPA Moleski interviewed 13 residents (R1-R13) and 10 staff members (S1-S10). LPA Moleski inspected all common areas in the facility, the kitchen and dining areas, and 13 residents’ rooms (R1-R13). Common areas and resident rooms were generally kept in clean and sanitary conditions, with no obvious hazards to health or safety.

All residents interviewed reported that they were satisfied with the cleanliness of the facility, and voiced no significant concerns regarding housekeeping or other sanitation measures. [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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 7
Control Number 27-AS-20250115102932
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: CITY CREEK ASSISTED LIVING
FACILITY NUMBER: 342700835
VISIT DATE: 03/13/2025
NARRATIVE
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In an interview, S3 said that on weekends, due to limited housekeeping staff, the floors and hallways get “kind of gross.” S6 also said there are not enough weekend housekeepers, although did not voice significant concerns with cleanliness in common areas or resident rooms. S6 said sometimes care staff have to wait to have housekeepers address issues on weekends. S6 said the kitchen, however, is not clean or hygienic. The facility housekeeping supervisor (S2) said that there are six housekeepers on duty during weekday morning shifts, plus a janitor. S2 said that there are three housekeepers on duty on weekends due to staff turnover, and they are actively hiring for these shifts. S9 said that housekeeping staff is “sometimes shorthanded,” but voiced no significant concerns regarding cleanliness. Other staff members interviewed did not have significant concerns regarding the cleanliness of resident rooms or common areas.

LPA Moleski toured this facility on 1/24/25. During an inspection of the facility’s kitchen, LPA Moleski observed that it was not kept in clean and sanitary conditions. LPA Moleski observed a variety of food materials dried and encrusted on a stovetop and a nearby countertop, including many strands of various kinds of pasta and other leftover food detritus. LPA Moleski observed grease stains on the stove and on the nearby countertop. LPA Moleski observed a large basin left on the stove, which was not in use, containing leftover grease and food debris. Adjacent walls and appliances had splattered grease stains on them. LPA Moleski observed various pieces of food debris scattered on the floor in the kitchen, stuck in floor drains, beneath appliances, on countertops, et cetera. LPA Moleski photographed these observations. LPA Pang Lee visited this facility four days after LPA Moleski's visit and photographed the exact same dried pasta and other food debris in food preparation areas. In an interview, the facility’s dining director (S7) said that kitchen cleanliness was “not up to standards” at the time of LPA Moleski’s initial visit, and that “some things were not getting done.” S7 said they had been working to correct the issues observed, and had drafted a cleaning task sheet for kitchen staff to ensure that the kitchen was kept clean. S7 provided LPA Moleski with a copy of this task sheet.

The department has determined the following as it relates to the allegation that the facility’s staff does not ensure the facility is kept in clean sanitary conditions at all times:

[continued on 9099-C]
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 27-AS-20250115102932
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: CITY CREEK ASSISTED LIVING
FACILITY NUMBER: 342700835
VISIT DATE: 03/13/2025
NARRATIVE
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Based on interviews and observation, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Section 87303(a). An exit interview was held with Flores. Appeal rights and a copy of this report were left with Flores.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7
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
01/15/2025 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250115102932

FACILITY NAME:CITY CREEK ASSISTED LIVINGFACILITY NUMBER:
342700835
ADMINISTRATOR:CALEB SUMMERHAYSFACILITY TYPE:
740
ADDRESS:6254 66TH AVENUETELEPHONE:
(916) 393-2324
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:121CENSUS: 113DATE:
03/13/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Katelyn FloresTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff does not ensure facility is kept free of insects.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski and Administrative Assistant Nicholas Morisi arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with Health Services Director Katelyn Flores and explained the purpose of the visit.

This investigation consisted of interviews, observation, and record review. LPA Moleski interviewed 13 residents (R1-R13) and 10 staff members (S1-S10). LPA Moleski inspected all common areas in the facility, the kitchen and dining areas, and 13 residents’ rooms (R1-R13). LPA Moleski did not observe any insects, nor any evidence of insect activity in any areas. Resident rooms appeared clean and were not maintained in a manner which would proliferate insect infestations.

In interviews, one resident (R13) said they had observed cockroaches in their bathroom around mid-February. [continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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 7
Control Number 27-AS-20250115102932
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: CITY CREEK ASSISTED LIVING
FACILITY NUMBER: 342700835
VISIT DATE: 03/13/2025
NARRATIVE
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R13 said that pest control personnel had previously sprayed in their room, around the beginning of the year. No staff members interviewed were aware of any issue with cockroaches in R13’s room.

In interviews, multiple staff members said that there was a problem with cockroaches in R1’s room when they moved in, because they brought cockroaches into the facility when they moved in. These staff interviews suggested that cockroaches also spread from R1’s room into the nearby staff break room. However, all staff members interviewed said that treatments were done in a timely manner, and that there had been no further issues with cockroaches afterward. In an interview, R1 said that they had not had any issues with cockroaches.

LPA Moleski reviewed six months' worth of pest control records for this facility, dated between 07/24 and 01/25. A report dated 7/8/24 indicated that there were German cockroaches in the break room. The break room, kitchen, interior baseboards and exterior foundations were treated using chemical pesticide. A report dated 7/30 indicated that treatment was performed in the laundry room, break room, dumpster area, and dining room were treated. A reported dated 8/29 indicated the kitchen, laundry room, and entire exterior were treated. The report indicated there were "no issues seen" and that there was "low rodent activity." A report dated 9/27 indicated that the facility exterior, exterior foundations, interior, kitchen, bathrooms, and break rooms were treated, and that bait stations were checked. A report dated 10/24 indicated that the kitchen, laundry room, and break room were treated. A report dated 10/28 indicated that the kitchen received "full roach treatment," and baits were added. The author of the report wrote that they "saw no roaches come out while treating kitchen." The dining room and baseboards were sprayed as well, according to the report. A report dated 11/21 indicated that the exterior and exterior foundations were treated. A report dated 12/10 indicated that the exterior, exterior foundations, and the interior baseboards were treated. The author of the report indicated service was done at a bait station. A report dated 12/19 indicated that the interior and interior baseboards were treated. The report also stated that there was a "full roach treatment" in rooms 103, 105, and 107, with liquid and aerosol chemical treatments and bait for roaches. A report dated 12/31 indicated that the interior and interior baseboards were treated, along with the laundry room, the kitchen, and bedrooms 107 and 105. A report dated 1/15 indicated that the exterior, exterior foundations, and interior baseboards were treated.

[continued on 9099-C]
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 27-AS-20250115102932
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: CITY CREEK ASSISTED LIVING
FACILITY NUMBER: 342700835
VISIT DATE: 03/13/2025
NARRATIVE
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The department has determined the following as it relates to the allegation that the facility’s staff does not ensure the facility is kept free of insects:

Based on interviews, observation, and record review, the above allegation is UNSUBSTANTIATED, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies were cited regarding the above allegation. An exit interview was held and a copy of this report was left with Flores.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 27-AS-20250115102932
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: CITY CREEK ASSISTED LIVING
FACILITY NUMBER: 342700835
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/14/2025
Section Cited
CCR
87303(a)
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 “The facility shall be clean … [and] … sanitary … at all times…” This requirement was not met as evidenced by:
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Licensee has drafted a cleaning checklist to correct the deficiency observed and to maintain kitchen cleanliness in the future. This POC will be cleared. vincent.moleski@dss.ca.gov
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Based on interviews and observation, facility kitchen areas were not kept in a clean or sanitary condition, which poses an immediate health, safety, and/or personal rights risk.
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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: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7