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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701176
Report Date: 08/27/2025
Date Signed: 08/27/2025 04:24:29 PM

Unsubstantiated


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
05/30/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250530083204
FACILITY NAME:CISTERS LOVING CARE HOME IIFACILITY NUMBER:
342701176
ADMINISTRATOR:FUENTES, FLORINDAFACILITY TYPE:
735
ADDRESS:5316 NECTAR CIRCLETELEPHONE:
(916) 897-3834
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:4CENSUS: 4DATE:
08/27/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Gil Del Carmen, Lead StaffTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff threatens resident.
Staff does not ensure resident is provided daily activities.
Staff does not safeguard resident's personal belongings.
Staff does not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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On 08/27/25, Licensing Program Analyst (LPA) Renee Campbell arrived to the community to present findings for a complaint. LPA Campbell met with Gil Del Carmen, Lead Staff and explained the purpose of the visit.

Regarding the allegation that staff threatened resident, when interviewed, R2, thought staff had said he would be kicked out R2 stated, he “didn’t know he was kidding” and that no other staff had threatened to kick him out. S1 also reported that staff had been joking since R2 and staff joke around a lot.

Regarding the allegation that staff does not ensure resident is provided daily activities, per R2 activities are no longer provided because of behaviors of other residents. R2 also reported that a recreational therapist had taken residents to ball games When S1 was interviewed, he confirmed that the recreational therapist had taken residents on outings but a new therapist had not yet been found.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
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-20250530083204
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: CISTERS LOVING CARE HOME II
FACILITY NUMBER: 342701176
VISIT DATE: 08/27/2025
NARRATIVE
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 LPA Campbell requested and received documentation of outings for June and July to Costco, KFC, Little Ceasar’s and other restaurants with the residents. S1 also stated staff took residents to the park to watch basketball games because they liked it.

Regarding the allegation that staff does not safeguard resident’s personal belongings, when asked, R2 stated no staff or other residents had taken his belongings or broke them. Instead, R2 stated he had been “pickpocketed” while in the park.

Regarding the allegation that staff does not treat resident with dignity and respect, R2 stated that staff blame him for everything because he is more high functioning. LPA Campbell asked what they blame him for, R2 responded, “They blame me for stuff when I joke around.” R2 could not provide further details. When LPA asked if staff shout at him or call him names, R2 stated no.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited.  Exit interview was held and a copy of report was given to Gil Del Carmen, Lead Staff.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2