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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700963
Report Date: 07/28/2026
Date Signed: 07/28/2026 11:35:11 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
06/12/2026 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20260612100622
FACILITY NAME:OARS AT GREENBACK LANE, THEFACILITY NUMBER:
342700963
ADMINISTRATOR:CHRISTAL ANDERSONFACILITY TYPE:
740
ADDRESS:6550 GREENBACK LANETELEPHONE:
(916) 212-0388
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:57CENSUS: 49DATE:
07/28/2026
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Rae Ortiz & Paige PerkinsTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff mishandling resident’s medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived on 07/28/2026 unannounced to conclude a complaint visit regarding the above allegation. LPA met with Memory Care Director Rae Ortiz and Paige Perkins Health Care Director and explained the purpose of the visit.
LPA conducted staff interviews regarding the allegations.

Please continue to LIC9099C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
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 3
Control Number 59-AS-20260612100622
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: OARS AT GREENBACK LANE, THE
FACILITY NUMBER: 342700963
VISIT DATE: 07/28/2026
NARRATIVE
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LPA interviewed staff regarding the allegations. LPA learned the following: R1 is prescribed two medications for pain: Acetaminophen 325 mg and Norco 5-325 mg. The directions for acetaminophen state “take 2 tabs (650 mg) by mouth every 4 hours as needed for breakthrough pain” while the directions for Norco state “take 1 tablet by mouth every 4 to 6 hours as needed for pain”. According to staff interviews, R1 will routinely as for a pain pill. Staff interviewed could not state the reasoning to give the acetaminophen rather than a Norco when R1 asked for a pain pill. According to R1’s MAR, there was no discernible pattern associated with the administration of each medication. Additionally, the prescribing physician was not contacted for clarification regarding which medication to give first for pain.

Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met.

Deficiency cited on 9099-D. Exit interview conducted. A copy of this report and appeal rights were provided.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260612100622
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: OARS AT GREENBACK LANE, THE
FACILITY NUMBER: 342700963
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2026
Section Cited
CCR
87465(a)(4)
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87465(a)(4) Incidental Medical and Dental Care(a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
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Facility to submit and come up with a plan to follow regarding when facility will contact primary physician for clarification.
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This requirement is not met as evidenced by: Based on interviews and file reviews the Licensee did not comply with the section cited above in facility did not contact the prescribing physician for clarification.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3