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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700945
Report Date: 12/17/2024
Date Signed: 12/17/2024 03:00:35 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
11/18/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241118115657
FACILITY NAME:WELLCARE HOMES 3FACILITY NUMBER:
342700945
ADMINISTRATOR:REYNELIZA U CAMALIGFACILITY TYPE:
737
ADDRESS:10799 SIMMERHORN RD.TELEPHONE:
(916) 639-0091
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:4CENSUS: 4DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jasmine PernellTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff are not keeping the facility at a comfortable temperature for clients
Licensee does not ensure that residents are delivered hot water through the home
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with Admintrator Jasmine Pernell, and explained the purpose of the visit.

The following has been determined as it relates to the aforementioned allegations. The investigation consisted of resident interviews, staff interviews, review of facility records, review of submitted pictures, and LPA Valerio's personal observation of the facility.

Facility staff are not keeping the facility at a comfortable temperature for clients:
LPA Valerio made an unannounced visit on 11/19/2024 and 12/03/2024. Each visit was during the afternoon and the temperature inside the facility was at 74 degrees Fahrenheit. LPA observed the facility thermostat to be located in the locked staff office.

Continues on LIC 9099 - C…
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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-20241118115657
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: WELLCARE HOMES 3
FACILITY NUMBER: 342700945
VISIT DATE: 12/17/2024
NARRATIVE
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Continued from LIC 9099
LPA Valerio conducted interviews with three (3) residents. R1 reported feeling comfortable at night time and does not feel cold. R2's interview was deemed unsuccessful due to communication barriers.  R3 reported R3 ensures everything is good and reported not having concerns.

LPA Valerio conducted interviews with staff members. Staff interviews were conducted with a staff from AM shift, PM shift, and NOC shift.  S1 reported that the thermostat is located in the staff office; therefore, staff have the capability to monitor and adjust the temperature of the facility. According to S1, the thermostat has not been an issue and has not received any reports of concern. S2 reported that the facility is always kept at a comfortable temperature. S3 reported that the facility temperature is not consistent depending on who is working. According to S3, there are lead staff who prohibit staff to turn on the heater.

LPA Valerio reviewed pictures submitted to the Regional Office (RO) by the reporting party. LPA Valerio was provided a picture of the thermostat on 11/18/2024. The pictured showed that the thermostat was turned off and the temperature inside the home was 60 degrees F, which is below the regulatory range of 68 - 85 degrees.   On 12/07/2024, a picture showed that the thermostat was set to cool setting at 70 degrees F. The temperature inside the home was 64 degrees F, which is below the regulatory range of 68 - 85 degrees F. Based on this information, the licensee did not ensure the temperature was set to a comfortable range during all hours of facility operation.

Licensee does not ensure that residents are delivered hot water through the home

LPA Valerio conducted unannounced visits on 11/19/2024 and 12/03/2024. On 11/19/2024, LPA measured the hot water temperature in both restrooms, which have a shower, toilet, and sink for resident use. The temperature was measured with a thermometer. The thermometer showed a reading of 102.9 degrees F for one restroom and 77 degrees F in other bathroom. On 12/03/2024, The water temperature was observed to be 108.0 and 112.3 degrees F in the bathrooms.

Continues on LIC 9099 - C, page 3...
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 27-AS-20241118115657
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: WELLCARE HOMES 3
FACILITY NUMBER: 342700945
VISIT DATE: 12/17/2024
NARRATIVE
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Continued from page 2
According to an interview with R1, R1 reported having no issues with the water and takes hot showers. R2's interview was deemed unsuccessful due to communication barriers. R3 reported that the hot water issue is being fixed.

According to an interview with S1, the facility has been having issues with the hot water in the facility; however, there are work orders for the issues. S1 reported clients have not been in distressed during this time. S2 reported having hot water in the kitchen sink and the laundry room. S3 reported the hot water working and also not working. S3 reported that the facility has been taking the clients to the hotel in order for them to take a shower.

According to a review of facility records, the licensee initiated staff to bring clients to a hotel to take hot showers on 11/24/24. This was being done when the facility did not have hot water in the bathrooms.

On 11/19/2024, LPA Valerio reviewed facility records for the hot water temperatures in the bathroom. LPA Valerio took pictures for future reference. LPA observed sticky notes on the left side of the staff water temperature log. The staff water temperature log for November 2024 only had 11/16/24 completely filled out. The rest of the days only had temperature readings of the kitchen sink and not the bathroom. The sticky notes on the left side were hand written by a staff member. The stick notes read the following:
      • 11/01/24 - No hot water BR1, 2, & 3
      • 11/02/2024- No hot water BR1, 2, & 3
      • 11/03/2024 - No hot water BR1, 2, & 3
      • 11/04/2024 - No hot water BR1, 2, & 3
      • 11/05/2024
      • 11/08/2024
      • 11/09/2024

Continues on LIC 9099 - C, page 4...
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 27-AS-20241118115657
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: WELLCARE HOMES 3
FACILITY NUMBER: 342700945
VISIT DATE: 12/17/2024
NARRATIVE
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Continued from page 3
      • 11/10/2024
      • 11/11/2024
      • 11/12/2024 75, 84, 92
      • 11/13/2024 78, 76, 75
      • 11/16/2024 NO HOT WATER
      • 11/17/2024 NO HOT WATER
      • 11/18/2024

On 11/27/2024, LPA Valerio received an email from Administrator Jasmine Pernell. The temperature readings for November 2024 were filled out. It was observed the facility bathrooms delivered hot water below the regulatory range of 105-120 for every day in November except for November 6 and November 22, 2024.

According to facility records, the facility put in a work order for the hot water on 11/13/2024, which was thirteen days after the initial observation of no hot water in the bathrooms. The facility had ABC plumbing service the facility on 11/13/24, 11/15/24, and 11/16/24. Due to the services not solving the issue permanently, ABC plumbing was scheduled to come out to the facility on 11/20/24, 11/21/24, 11/25/24, and on 11/27/2024. On 11/27/2024, the facility was waiting on a quote for a replacement of new water heater.

Based on the above noted information,  the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided.  An exit interview was conducted Admintrator Jasmine Pernell, and a copy of the report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 27-AS-20241118115657
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: WELLCARE HOMES 3
FACILITY NUMBER: 342700945
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/18/2024
Section Cited
CCR
80088(e)
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80088 Furniture, Fixtures, Equipment, and Supplies (e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. This requirement was not met as evidenced by:
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Licensee stated the water heater has been replaced and the current water temperatures are within regulatory range. Licensee provided a copy of the current temperatures for December.
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Based on records review and interviews, the licensee did not did not put in a work order until 11/13/24 after observing the hot water to be under 105 degrees on 11/01/24 and did not secure a location for showers until 11/24/24, which poses an immediate risk to residents in care.
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POC cleared during the visit.
Type A
12/18/2024
Section Cited
CCR
80088(a)(1)
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80088 Furniture, Fixtures, Equipment, and Supplies (a)A comfortable temperature for clients shall be maintained..(1)... between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C). This requirement was not met as evidenced by:
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Licensee stated an in-service training was conducted with all staff members, including lead staff.. LPA Valerio to receive a copy of the in-service training for 80088(a)(1). LPA Valerio was provided copies of the in-service along with the sign in sheet during 12/17/24 visit.
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Based on review of pictures obtained, the licensee did not ensure the facility was maintained at a comfortable temperature and had a facility temperature of 60 and 64 degree F during NOC shift, which poses an immediate health, safety, and personal rights risk to residents in care.
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POC cleared during the visit.
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: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 5 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
11/18/2024 and conducted by Evaluator Christina Valerio
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241118115657

FACILITY NAME:WELLCARE HOMES 3FACILITY NUMBER:
342700945
ADMINISTRATOR:REYNELIZA U CAMALIGFACILITY TYPE:
737
ADDRESS:10799 SIMMERHORN RD.TELEPHONE:
(916) 639-0091
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:4CENSUS: 4DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jasmine PernellTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff are not properly addressing pest infestation in facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with Admintrator Jasmine Pernell, and explained the purpose of the visit.

The following has been determined as it relates to the aforementioned allegations. The investigation consisted of resident interviews, staff interviews, review of facility records, review of submitted pictures, and LPA Valerio's personal observation of the facility.

LPA Valerio made an unannounced visit on 11/19/2024 and 12/03/2024. LPA Valerio observed traps for rodents to be placed in a resident bedroom, a common area, and in the facility garage. The traps were observed to be made of paper materials and a sticky substance. The traps were not observed to be hazardous to residents in care. LPA Valerio did not observe any rodents during each visit.
Continues on LIC 9099 - C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 27-AS-20241118115657
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: WELLCARE HOMES 3
FACILITY NUMBER: 342700945
VISIT DATE: 12/17/2024
NARRATIVE
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Continued from LIC 9099 - A

LPA Valerio conducted interviews with three (3) residents. Resident 1 (R1) stated the mice is their friend. R1 stated R1 would let the mouse free if the trap catches the mouse. R1 stated only staff saw the mouse and reported being comfortable. R2's interview was deemed unsuccessful due to communication barriers. R2 reported never seeing any bugs or mouse in the home. R3 stated the facility is always clean.

LPA Valerio interviewed staff. S1 stated the facility has seen mice in the home. S1 believes it is because the city is doing construction where it used to be an open field. S1 stated the first saw it in the garage but then saw one in a resident's room. S1 stated the facility has a pest control service with Eco Lab, which have been coming to the facility a few times. S2 reported that there is currently not a rodent issue; however, if they see one, they have used a pest control service. S3 reported that there was mice in the garage and in staff belongings. S3 stated the rodents are in the garage where they keep the food. S3 stated since there are no chairs in the dining room, a resident will sometimes eat outside in the garage. 

LPA Valerio reviewed work order submitted by the facility to Eco Lab. LPA Valerio observed multiple work orders to search for rodents, install traps, and to provide other pest services.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, \no deficiencies cited. An exit interview was held an a copy of report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7