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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 11/23/2022
Date Signed: 11/23/2022 12:57:07 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2022 and conducted by Evaluator Kesha Lewis
COMPLAINT CONTROL NUMBER: 27-AS-20221122143911
FACILITY NAME:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:MITITI, BIANCAFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 4DATE:
11/23/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Beatrice Clark and Timothy ClarkTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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On 11/23/22 Licensing Program Analysts (LPAs) Maja Jensen and Kesha Lewis arrived at facility unannounced to open a complaint investigation in to the above listed allegation. LPAs Lewis and Jensen met with Licensees Beatrice Clark and Timothy Clark and explained the purpose of today's visit.

LPAs Jensen and Lewis toured the interior and exterior of the facility. The exterior was observed to be well maintained and all pathways were free of obstruction. The window screens were observed to be in good repair. There are no bodies of water on the premises. The interior of the facility was observed to be sanitary and free of odor. There was adequate lighting and furniture observed in the facility for the comfort of the residents. LPA Jensen inspected and tested all appliances and found them to be in good repair. LPA Jensen ran the water in the bathrooms and did not observe any leaks or pooling. No damage was noted to windows, flooring, walls or doors. Based on LPAs facility observations during the course of this visit, the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have occurred, the preponderance of evidence standard has not been met.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
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 27-AS-20221122143911
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
VISIT DATE: 11/23/2022
NARRATIVE
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No deficiencies are being cited. An exit interview was conducted and a copy of this interview and appeal rights were provided to the Licensee.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha LewisTELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2