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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 05/06/2025
Date Signed: 05/06/2025 09:44:54 AM

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
03/11/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250311081533
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: 110DATE:
05/06/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Celeb SummerhaysTIME COMPLETED:
09:00 AM
ALLEGATION(S):
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Staff/resident pulled residents hair
Staff stole residents’ money
Staff do not intervene when resident calls another resident name
INVESTIGATION FINDINGS:
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On 05/05/25 Licensing Program Analysts (LPAs) Pang Lee and Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPAs met with XXXXX and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is110.

It was alleged that staff/resident pulled residents hair, staff do not intervene when resident calls another resident name and staff stole residents’ money. The investigation included interviews with staff and residents, as well as a review of facility records. LPA Lee interviewed 8 out of 9 residents who stated they had not witnessed any incidents of staff or residents pulling another resident's hair and reported no concerns in that regard. Additionally, all 9 residents interviewed confirmed that when conflicts arise between residents, staff intervene appropriately, assist with problem-solving, and separate individuals when necessary. 8 out of 9 residents stated they feel safe living in the facility.

Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
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 2
Control Number 27-AS-20250311081533
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: 05/06/2025
NARRATIVE
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Furthermore, none of the 9 residents interviewed reported experiencing or hearing of any incidents involving staff stealing residents' money. Resident #1 (R1) stated they do not keep any money at the facility and didn’t have any money. According to R1's Individual Service Plan (ISP), R1 has a diagnosis of dementia and has expressed concerns about people stealing R1’s cigarettes and money and setting R1 on fire. LPA Lee also interviewed all 5 staff members on duty. All denied the allegations and affirmed that they are trained to intervene in conflicts between residents and to assist with resolving disputes.

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 violation(s)occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2