342700949-7-25-2025-27-AS-KHOS-DK4P6N-20250731110237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700949
Report Date: 07/25/2025
Date Signed: 07/25/2025 03:37:52 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
06/18/2025 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250618141211

FACILITY NAME:	FIELDALE FACILITY		FACILITY NUMBER:	342700949
ADMINISTRATOR:	HUFF, MARCUS		FACILITY TYPE:	735
ADDRESS:	6261 FIELDALE DRIVE		TELEPHONE:	(323) 459-8068
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	4	CENSUS: 2	DATE:	07/25/2025
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Michael Oliva		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff restrained resident
Staff poured water on resident while resident slept
Staff forced resident to take their medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Michael Oliva and explained the purpose of the visit.

This investigation consisted of interviews and record review. LPA Moleski interviewed Oliva, two staff members (S1-S2), a resident (R1), and a representative of Alta California Regional Center (ACRC).

In an interview, Oliva said that R1 had claimed a staff member (S1) held R1 down, forced them to take their medication, and threw water on them to wake them up. Oliva said these claims were made on May 30, 2025, shortly after R1 had refused their medications. LPA Moleski reviewed a staff schedule for the month of May 2025, and observed that S1 and S2 were scheduled to work on May 30 for the afternoon and morning shifts, respectively. S2 was scheduled between 8 a.m. and 3 p.m., and S1 was scheduled between 2 p.m. and 9 p.m. [continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

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-20250618141211

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: FIELDALE FACILITY	FACILITY NUMBER: 342700949
	VISIT DATE: 07/25/2025

NARRATIVE

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LPA Moleski reviewed daily notes pertaining to R1. A note written by S2 on May 30, 2025 stated the following: S2 attempted to wake R1 at 11:30 a.m. in order for R1 to take their medication, but R1 didn't wake up. S2 notified the administrator, who texted and called R1 in an attempt to wake R1. S2 continued to "go back and forth to wake up the resident" until noon. Later, S1 attempted to give R1 their medication. R1 woke up, got angry, and accused S1 of trying to shove medication in their mouth and attempting to hit R1. R1 called the administrator, reiterated these allegations, and called 911. Two administrators arrived later, and R1 took their medications. Nothing else of note was documented that day.

In an interview, S1 denied the allegations. S1 said that, on the morning in question, S2 had been unsuccessful in waking R1 to take their medications, so suggested that S1 try. S1 said they went to R1’s bedroom door and knocked, but did not enter. S1 said they explained to R1 that it was late, and asked if R1 wanted to take their medications. However, S1 said, R1 began screaming in response, alleging they were being forced to take their medications.

In an interview, S2 said that they had been periodically knocking on R1’s door for several minutes at a time on the morning of May 30, but R1 was not getting up. S2 said that when S1 arrived, around 2 p.m., S2 asked S1 to try to give R1 their medications. S2 said that they remained in the living room while S1 went toward R1’s room, so they didn’t see exactly what happened. However, S2 said they heard S1 entering R1’s room, S1 offering R1 medication, and R1 yelling in response. S2 said they saw S1 walk toward R1’s room with a glass of water and a cup of medication. S2 said S1 walked back from the direction of R1’s room with the same glass of water, containing the same amount of fluid.

In an interview at a new placement, R1 spoke positively about their time at this facility. R1 said that this facility was “more supportive about freedom,” and said they wanted to “make amends” and move back in. R1 said that two staff members (S1, S3) weren’t nice, but when LPA Moleski asked for clarification on what they did that wasn’t nice, R1 said they didn’t cook well. When LPA Moleski asked about the allegations made in this complaint, R1 said they were “not sure if it really happened.” R1 also gave contradictory statements. R1 said that they “felt water fall on” them, but also said that they were “the one who once threw water on them [the staff].”

[continued on 9099-C]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20250618141211

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: FIELDALE FACILITY	FACILITY NUMBER: 342700949
	VISIT DATE: 07/25/2025

NARRATIVE

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When LPA Moleski asked if anyone had forced R1 to take their medications, R1 said they were being forced every day. When LPA Moleski asked how they were being forced to take their medications, R1 said that people “slam on their door.” R1 denied that staff had ever physically abused them, but said they were afraid that someone might shove medications down their throat until they choked.

LPA Moleski reviewed R1’s Individual Program Plan (IPP). According to the IPP, staff have reported that R1 has accused staff of yelling at R1 or hitting R1’s bed to wake R1 up. However, R1 has reported that R1 "just doesn't like to be woken up to take [their] medication and will request to push back the time." When R1 doesn't take their medications, they have “more verbal outbursts and experiences paranoia," according to the IPP.

The department has determined the following as it relates to the allegations that staff restrained a resident, that staff poured water on a resident while the resident slept, and that staff forced a resident to take their medication:

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

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Oliva.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025

LIC9099 (FAS) - (06/04)

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