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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701030
Report Date: 07/14/2026
Date Signed: 07/14/2026 10:33:39 AM

Unfounded


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
03/02/2026 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20260302120552
FACILITY NAME:SUNGARDEN VILLA IVFACILITY NUMBER:
342701030
ADMINISTRATOR:ROBINSON, RUSSELLEFACILITY TYPE:
740
ADDRESS:303 OAK CANYON WAYTELEPHONE:
(916) 904-0221
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:6CENSUS: 5DATE:
07/14/2026
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Russelle RobinsonTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility call light system inoperable.
Facility failed to meet resident's incontinence needs.
Staff do not treat resident's with dignity or respect.
Resident's personal belongings are inaccessible.
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Russelle Robinson to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***
Unfounded
Estimated Days of Completion: 10
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026
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 2
Control Number 59-AS-20260302120552
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: SUNGARDEN VILLA IV
FACILITY NUMBER: 342701030
VISIT DATE: 07/14/2026
NARRATIVE
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Facility call light system inoperable.

Interviews conducted indicated that all call button systems are operational in the home. Staff demonstrated how the call light system works within the home, pressing the buttons and showing how the detection system works in each room. Observations indicated that call light button system is operational. Residents either have a button or monitors to detect movement within the room. Staff are then alerted of the room via an audible system heard anywhere in the home. Staff then respond to the correct room in a timely manner. Therefore, the allegation facility call light system inoperable is unfounded.

Facility failed to meet resident's incontinence needs.

Interviews conducted indicated that residents are changed every 3-4 hours or sooner if needed. Staff also assist residents to the toilet if they are able to use it. Staff continue to monitor for signs of redness or rashes from the depends and will address as necessary. Residents are able to verbalize when they need to be changed. Observations indicated that restrooms are accessible for residents in care. Staff are also changing as needed. Therefore, the allegation facility failed to meet resident’s incontinence needs is unfounded.

Staff do not treat resident's with dignity or respect.

Interviews conducted with R1 and R2 indicated that they feel that they are treated with dignity. Staff assist with their daily needs. Staff indicated that residents are treated with dignity and respect. Staff are willing to assist with anything the resident needs. Observations indicated that staff are assisting residents in care with dignity and respect. Staff take their time with each resident and ensure that they are comfortable. Records reviewed indicated that staff have received training on resident care and treating residents with dignity and respect. Therefore, the allegation staff do not treat resident’s with dignity or respect is unfounded.

Resident's personal belongings are inaccessible.

Interviews conducted indicated that each resident’s belongings are available to the resident at any time. Staff will assist residents when they are unable to reach their belongings or need items like shampoo or soap. Observations indicated that resident’s personal belongings are within reach. Some personal items like soap and shampoo are stored in a locked cabinet for safety. Each resident has their own items in their room all at an accessible level of reach. Therefore, the allegation resident’s personal belonging are inaccessible is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2