342700835-2-5-2026-27-AS-SRIN-DS9Q95-20260317115746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700835
Report Date: 02/05/2026
Date Signed: 02/05/2026 12:28:16 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
12/30/2025 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20251230132456

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: 112	DATE:	02/05/2026
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Katelyn Flores		TIME COMPLETED:	12:46 PM

ALLEGATION(S):

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Staff do not ensure resident's room is clean and sanitary
Facility is malodorous
Staff do not ensure resident is capable of operating oxygen equipment

INVESTIGATION FINDINGS:

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On 02/05/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Health Services Director (HSD) Katelyn Flores 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 112.

It was alleged that staff do not ensure resident's room is clean and sanitary and that the facility is malodorous. This investigation consisted of interviews with staff, residents, and the resident’s responsible party (RP), as well as direct observations. LPA Lee interviewed seven of seven residents, all of whom reported no concerns regarding their rooms being unclean and unsanitary, and no concerns regarding malodorous conditions within the facility and stated that their rooms are clean daily. Additionally, Resident 1 (R1) stated that housekeeping staff clean R1’s room daily and reported no concerns.
CONTINUED LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

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-20251230132456

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: 02/05/2026

NARRATIVE

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Interviews with facility staff indicated that housekeeping staff are assigned by resident hall and by shift. Each hall (Hall 1, Hall 2, and Hall 3) has designated housekeeping coverage during the AM and day shift and in addition to a janitor. R1’s responsible party reported no concerns regarding R1’s room being unclean, unsanitary, or malodorous, and stated that R1 at times refuses housekeeping services. During visits conducted on 01/06/2026 and 02/05/2026, LPA Lee toured the facility, including multiple resident rooms, and did not observe any rooms to be unclean, unsanitary, or malodorous. On both visits, LPA Lee observed housekeepers assigned to each resident hall cleaning throughout the facility. During both visits, Room 317, occupied by R1, was observed to be clean and free of malodor. LPA Lee observed two plastic cups and tissues on the resident’s chair. It was learned that R1 prefers that the plastic cups and tissues not be discarded when housekeeping offers to remove them. Based on interviews and observations conducted during the investigation, LPA Lee was unable to corroborate the allegations.

It was alleged that the staff do not ensure resident is capable of operating oxygen equipment.
This investigation consisted of interviews with staff, the residents, the resident’s responsible party, direct observations, and a review of records. Based on interviews with facility staff, it was reported that the resident is capable of operating their oxygen and CPAP machines. Resident 1 (R1) stated that they know how to operate their oxygen and CPAP machines and reported no concerns regarding the allegation. R1’s responsible party also reported no concerns and stated that R1 is able to operate the oxygen and CPAP machines; however, they reported that R1 at times refuses to use the equipment and described R1 as “non-compliant.” On 01/06/2026, with Health Services Director (HSD) Flores present, R1 demonstrated the use of their oxygen and CPAP machines. R1 independently demonstrated turning the machines on and off and properly placing the oxygen tubing in their nose. Based on R1’s Individual Service Plan, R1 is capable of properly using the CPAP machine but at times declines due to low motivation. R1 also receives oxygen treatment, which is self-managed; however, R1 can occasionally be non-compliant with physician orders. Based on interviews and observations conducted during the investigation, LPA Lee was unable to corroborate the allegation.

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: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

LIC9099 (FAS) - (06/04)

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