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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701176
Report Date: 11/04/2025
Date Signed: 11/04/2025 10:53:59 AM

Document Has Been Signed on 11/04/2025 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CISTERS LOVING CARE HOME IIFACILITY NUMBER:
342701176
ADMINISTRATOR/
DIRECTOR:		FUENTES, FLORINDAFACILITY TYPE:
735
ADDRESS:5316 NECTAR CIRCLETELEPHONE:
(916) 897-3834
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY: 4CENSUS: 3DATE:
11/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Florinda FuentesTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to follow up on an incident report sent to LPA on 11/03/2025 at 5:00 PM by Licensee Rochelle Cister. LPA Valerio met with Administrator Florinda Fuentes, and explained the purpose of the visit. LPA Valerio contacted Licensee Rochelle Cister via cell phone.

The incident report dated 11/02/2025 stated multiple staff came forward to report physical abuse towards Resident 1 (R1) by Staff 1 (S1). Based on internal investigation, on October 17, 2025, S1 allegedly abused R1 while changing R1's diaper. Staff 2 (S2) witnessed S1 hitting R1 arm using an open fist once during the diaper change. S2 reported did not report the incident immediately due to the fear of S1. S2 reported the incident on November 2, 2025. Staff 3 (S3) confirmed seeing S1 harming R1 using an open fist during a diaper change on a different date. S3 could not recall the date of the incident. S3 did not report right away due to the fear of S1. Throughout the investigation, it was learned that two additional staff, Staff 4 (S4) and Staff 5 (S5), have observed S1 using an open fist toward R1 and could not recall the date of incident.

S1 was terminated on November 2, 2025 by the Licensee due to "multiple incident of alleged client abuse, violations of company polices regarding client care and safety; creation of intimidating work environment that prevented timely incident reporting"

Action Taken by Facility: S1 was terminated effective November 02, 2025. R1 was assessed for injuries by other employees during these incidents and no injuries noted. Mandatory reporting to appropriate authorities completed and SOC 341 submitted on 11/03/2025.
Continues on LIC 809-C...
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Christina Valerio
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CISTERS LOVING CARE HOME II
FACILITY NUMBER: 342701176
VISIT DATE: 11/04/2025
NARRATIVE
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LPA Valerio was notified that local law enforcement was notified by Licensee Rochelle.

During today's visit, LPA Valerio obtained copies of staff files and interviewed staff. LPA attempted to get written statement from witnessing staff; however, staff were not available, not on shift, or have been terminated.

According to Licensee Rochelle, the facility has been doing 1:1 staff meetings since October 28, 2025 due to the substantiated complaint (27-AS-20251006132945). On November 01, 2025, the facility conducted an all staff meeting on the following topics: Client Abuse and Neglect Prevention Policy, Zero Tolerance Policy, SOC 341, Client Rights, Mandatory Reporter Training, Workplace Safety and reporting procedures training, Family member shift separation policy

Per California Code of Regulations - 80072(a)(3) and 80061(d) are being cited on the attached LIC 809 - D page.

An exit interview was held with Licensee Rochelle via cell phone and Administrator Florinda in-person, an a copy of this report was provided.

Appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Christina Valerio
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/04/2025 10:53 AM - It Cannot Be Edited


Created By: Christina Valerio On 11/04/2025 at 08:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CISTERS LOVING CARE HOME II
FACILITY NUMBER: 342701176

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2025
Section Cited
CCR
80072(a)(3)

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80072 Personal Rights (a)... each client shall have personal rights which include, but are not limited to, the following:
(3) To be free from corporal or unusual punishment, infliction of pain.... This requirement was not met as evidenced by:
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Licensee stated they will send a detailed plan to LPA Valerio by POC due date. The hired an outside vendor to conduct Clients Care and Supervision Training and Use of Restraints Training. Licensee has terminated employees and increased monitoring by conducting unannounced visits.
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Based on statements collected from S2, S3, S4, and S5, the licensee did not ensure R1 was free from physical abuse from S1, which is an immediate health, safety, and personal rights risk to residents in care.
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Type A
11/05/2025
Section Cited
CCR80061(d)

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80061 Reporting Requirements (d) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as...
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Licensee stated they will be and have been increasing staff training. All staff will be required to attend a Client Rights training and Mandated Reporting Training with Alta California Regional Center at their office. LPA Valerio to receive dates of training by POC due date.
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..required by Welfare and Institutions Code Section 15630(b)(1). This requirement was not met as evidenced by: Based on staff statements, the licensee did not ensure staff reported the physical abuse of R1 when the act was observed, which poses an immediate risk to residents 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.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Christina Valerio
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2025


LIC809 (FAS) - (06/04)
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