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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 08/04/2026
Date Signed: 08/05/2026 03:10:15 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
06/05/2026 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260605084138
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: 5DATE:
08/04/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Beatrice Clark TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff did not ensure that the resident’s wound care needs were met at the facility
Staff did not ensure that the resident’s insulin care needs were met at the facility
Staff did not arrange transportation for the resident to attend medical appointments
Staff did not maintain resident records
Staff did not meet the resident's hygiene care needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA'S) Kesha Lewis arrived to the facility unannounced to continue a complaint investigation into the allegations above. LPA Lewis met with Licensee Beatrice Clark, and explained the purpose of the visit.

LPA Lewis interviewed Licensee Beatrice Clark, and requested to see R1'S file. Based on the licensee not being able to prudce a compleate file for review and LPA lewis interview with R1'S physican and confirming multiple appoitments were missed. The above allegations are SUBSTANTIATED. A finding of SUBSTANTIATED means the 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.









An exit interview was held, and a copy of this report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026
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 27-AS-20260605084138
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: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2026
Section Cited
CCR
87465(a)(2)
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87465 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:
(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the residents’ need. In providing transportation the licensee shall do so directly or make arrangements for this service.
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The Licensee will provide a statment of understanding to LPA Lewis By COB 08/06/2026.

Kesha.Lewis@dss.ca.gov
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Based on interviews with S1 and S2. The licensee did not ensure R1 made it to doctors appoitments on multiple occations. This poses a potential health, safety, and/or personal rights risk.
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Type A
08/06/2026
Section Cited
CCR
87506(b)(14)
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87506 Resident Records
(b) Each resident’s record shall contain at least the following information:
(14) Current centrally stored medications as specified in Section 87465, Incidental Medical and Dental Care Services.

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The Licensee will provide a statment of understanding to LPA Lewis By COB 08/06/2026.

Kesha.Lewis@dss.ca.gov
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Based on records review the licensee was not able to provide R'S file for LPA to review. Which poses an immediate health, safety, and/or personal rights risk.
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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: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260605084138
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: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2026
Section Cited
CCR
87208(a)
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87208 Plan of Operation
(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:
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The Licensee will provide a statment of understanding to LPA Lewis By COB 08/06/2026.

Kesha.Lewis@dss.ca.gov
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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: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3