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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 06/16/2026
Date Signed: 06/16/2026 03:54:41 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
11/13/2025 and conducted by Evaluator Melina Oropeza
COMPLAINT CONTROL NUMBER: 27-AS-20251113171326
FACILITY NAME:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:CLARK, TIMOTHYFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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2
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9
Staff do not provide activities for resident.
INVESTIGATION FINDINGS:
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2
3
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13
Licensing Program Analysts (LPA) Melina Oropeza and Kesha Lewis arrived to the facility unannounced to conduct a complaint investigation visit. LPAs Oropeza and Lewis met with Licensee Beatrice Clark, and explained the purpose of the visit.

LPA Oropeza toured the facility and observed residents in their bedrooms and common area. During the visit, no activities were observed being conducted and staff were not observed encouraging or assisting residents to participate in activities.

LPA interviewed Resident 1 (R1), who reported not participating in activities and had not observed activities being provided. The administrator provided an activity calendar, however, activities schedule for today were not listed on the calendar.

see page c...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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 4
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
11/13/2025 and conducted by Evaluator Melina Oropeza
COMPLAINT CONTROL NUMBER: 27-AS-20251113171326

FACILITY NAME:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:CLARK, TIMOTHYFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Melina Oropeza and Kesha Lewis arrived to the facility unannounced to conduct a complaint investigation visit. LPAs Oropeza and Lewis met with Licensee Beatrice Clark, and explained the purpose of the visit.

LPA Oropeza reviewed resident records, including LIC 62. LPA verified completed and signed LIC 621 forms for Residents 1, 2 and 3(R1) (R2) (R3). LPA interviewed R3 sister, who reported the resident does not maintain valuables at the facility and that personal valuables are kept by the family. The Administrator reported a LIC 621 will be completed and signed for Resident 3.

Based on records reviewed and interviews conducted, insufficient evidence was obtained to support the allegation that staff failed to safeguard residents’ personal belongings. The allegation is unsubstantiated.

An exit interview was conducted and a copy of this report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20251113171326
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: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
VISIT DATE: 06/16/2026
NARRATIVE
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Based on LPA observations, interview and activity calendar review, the preponderance of
evidence standard has been met, therefore the above allegation is found to be Substantiated.

Citations are being issued today per California Code of regulation Title 22 see 9099D page.

An exit interview was held, and a copy of this report and appeal rights was provided to administrator
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20251113171326
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: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2026
Section Cited
CCR
87219(a)
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7

87219 Planned Activities (a)Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities.
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The licensee will provide any documentation of refusal of resident participating in activities. The licensee will send updated activity calendar by 5:00pm on June 30, 2026.
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Based on observations, interviews and documentation received. LPA did not observe residents participating in activities during this visit.
Which poses a potential health, safety, or
personal rights risk to persons in care.
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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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4