342700835-9-25-2025-27-AS-CACL-DM7T3B-20251006142205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 09/25/2025
Date Signed: 09/25/2025 02:16:52 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
06/30/2025 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250630162820

FACILITY NAME:	CITY CREEK ASSISTED LIVING		FACILITY NUMBER:	342700835
ADMINISTRATOR:	CALEB SUMMERHAYS		FACILITY TYPE:	740
ADDRESS:	6254 66TH AVENUE		TELEPHONE:	(916) 393-2324
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	121	CENSUS: 107	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	01:12 PM
MET WITH:	Leslie Padilla		TIME COMPLETED:	02:36 PM

ALLEGATION(S):

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Facility not meeting resident's needs.
Facility food provided to the resident does not meet resident’s needs.
Resident fell due to lack of supervision.
Facility has insufficient staff to meet residents’ needs.
Facility staff did not prevent resident altercations.
Resident was physically abused while in care.

INVESTIGATION FINDINGS:

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On 09/25/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Assistant Living Waiver Program Director (ALWP), Leslie Padilla and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. The current census is 107. A brief interview conducted with ALWP Padilla.

It was alleged that the facility is not meeting resident's needs and that the facility food provided to the resident does not meet resident’s needs. This investigation involved observations, a review of facility records, and interviews with both staff and residents. During a visit on 07/24/2025, LPA observed resident aids (RA) assisting residents with mobility needs, including helping residents get out of bed and to the bathroom. Residents were seen attending meals in the dining room during both breakfast and lunch.

CONTINUED LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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-20250630162820

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: 09/25/2025

NARRATIVE

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Additionally, some meals were delivered directly to residents' rooms. A follow-up visit was conducted on 09/16/2025. During this visit, LPA toured the facility and observed lunch being served in the dining room. Several residents were assisted in the dining area. Three (RAs) were seen helping residents with feeding, opening food containers, and providing supervision. Two med-techs were observed distributing medications, and kitchen staff were seen delivering meals in and out of the dining room. In total, LPA observed five med-techs and seven resident aides on duty. LPA observed Resident 1 (R1) receiving lunch via room service and being assisted with feeding. On both visits, LPA verified that the facility had a sufficient supply of food: a minimum of two days’ worth of perishable and seven days’ worth of non-perishable food items. According to R1’s care documentation, including progress notes from February 2025 to July 2025, R1 receives meals either in the dining room or through room service and sometimes refuses to eat. It was also learned that (R1) was placed on hospice care on 02/14/2025. Hospice services were provided in coordination with the facility. According to the records reviewed, there were ongoing communication, and three care conferences held involving the resident’s responsible party, hospice, and the facility. The notes confirm that R1 is consistently provided with food and liquids. Interviews were conducted with both residents and staff. All 7 out of 7 residents interviewed stated they had no concerns regarding the staff meeting their needs or the adequacy of the food provided. R1 stated that R1 likes the food being served to R1 and is receiving sufficient food and water and has no complaints. Additionally, 7 out of 7 staff members interviewed denied any allegations of neglect and staff are not meeting resident needs. Based on the observations, record reviews, and interviews conducted, there is insufficient evidence to determine whether the alleged violations occurred.

It was alleged that resident fell due to lack of supervision and facility has insufficient staff to meet residents’ needs. This investigation involved observations, a review of facility records, and interviews with both staff and residents. During two facility visits conducted on 07/24/2025 and 09/16/2025, LPA Lee observed residents being assisted with activities of daily living (ADLs). Resident aides (RAs), Med-Techs, and kitchen staff were seen supervising and assisting residents in the dining area during mealtimes. It was learned that the facility is divided into three residential halls and in each hall, there are two resident aides and two Med-Techs to support residents in care. Interviews were conducted with 7 out of 7 residents and 7 out of 7 staff members. All interviewees stated that they had no concerns regarding supervision and insufficient staff to meet the residents’ needs. Based on the observations, record reviews, and interviews, there is insufficient evidence to determine whether the alleged violations occurred.

CONTINUED LIC 9099-C

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250630162820

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: 09/25/2025

NARRATIVE

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It was alleged that facility staff did not prevent resident altercations and that residents were physically abused while in care. This investigation involved a review of records and interviews with facility staff and Resident 1 (R1). According to an incident report dated 11/13/2022, R1 was in the dining room with another resident, Resident 2 (R2). R2 was blocking the pathway, preventing another resident from passing. R1 asked R2 to scoot forward to allow the other residents’ through. When R2 did not respond, R1 pushed R2 backward while R2 was seated in a chair. Facility staff immediately assessed both residents. No injuries were observed for either R1 or R2. Interviews were conducted with 7 out of 7 residents, all of whom stated they had no concerns about staff not preventing resident altercations and feels safe living in the facility. They reported that staff do intervene when altercations occur. Furthermore, all residents interviewed confirmed they had not witnessed any residents being knocked and losing teeth due to altercations. In an interview, R1 stated that R1 does not recall any incident where R1 was knocked out by another resident and had six teeth knocked out. Based on the information obtained and interviews conducted, there is insufficient evidence to determine whether the alleged violations occurred.

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.

An exit interview was conducted, and a copy of this report were provided to the facility at the end of this visit.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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