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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701228
Report Date: 02/03/2026
Date Signed: 02/03/2026 02:53:22 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
01/02/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260102141541
FACILITY NAME:COMFORT LIVING ELDER CARE 3FACILITY NUMBER:
342701228
ADMINISTRATOR:SOUMAHORO, MARIAM GFACILITY TYPE:
740
ADDRESS:8765 INISHEER WAYTELEPHONE:
(510) 409-7096
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 5DATE:
02/03/2026
UNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Facility Staff: Lily CrawfordTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not meet resident's incontinence care needs.
Staff yell at resident.
Staff do not safeguard resident's confidential information.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 2/3/2026 at 2:20 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility staff Lily Crawford and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 5.

Allegation: Staff do not meet resident's incontinence care needs
It was alleged that staff do not meet resident’s incontinent care needs. This investigation consisted of interviews with facility staff and residents, and records review. On 01/07/2026 LPA Hughes conducted a visit to the facility and spoke with 2 out of 3 facility staff. Interview with the facility administrator stated that facility staff should be checking on residents in 15-minute intervals, stating that (2) residents in the facility require assistance with grooming and dressing. Interview with facility staff (S2) stated that they primarily assist resident (R1) with changing undergarments.

Continuation 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
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 2
Control Number 27-AS-20260102141541
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: COMFORT LIVING ELDER CARE 3
FACILITY NUMBER: 342701228
VISIT DATE: 02/03/2026
NARRATIVE
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2
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4
5
6
7
8
9
10
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32
Interview with resident (R1) stated that facility staff do meet their incontinent care needs. Additional interviews with 2 out of 3 residents did not express any concerns about facility staff not meeting their grooming and care needs, as they do not require assistance from staff. LPA attempted interview with resident (R4) but was unable as they have limited verbal capacity. LPA reviewed facility care charting records for resident (R1), for the months of November 2025, December 2025, and January 2026 and observed daily incontinent care changing for resident (R1) however the record did not specify times. There is not enough evidence to corroborate this allegation, therefore the allegation is unsubstantiated.

Allegation: Staff yell at resident

It was alleged that staff yell at a resident in care. This investigation consisted of interviews with facility staff, and residents in care. On 01/07/2026 LPA Hughes conducted a visit to the facility. LPA spoke with 2 out of 3 facility staff who denied allegations of ever yelling at residents in care. LPA spoke with 2 out of 3 residents who stated they have no concerns about facility staff yelling at them or have ever observed staff yelling at other residents. Interview with resident (R1) reflected that staff do not yell at them. LPA attempted to interview 2 additional residents in care but was unable as both residents have limited English speaking capabilities. There is not enough information present to corroborate this allegation, therefore the allegation is unsubstantiated.

Allegation: Staff do not safeguard resident's confidential information

It was alleged that staff do not safeguard resident’s confidential information. This investigation consisted of interviews with facility staff and residents in care. On 01/07/2026 LPA Hughes conducted a visit to the facility. LPA spoke with 2 out of 3 facility staff who denied allegations of disclosing resident’s confidential information. LPA spoke with 2 out of 3 residents in care who stated that staff have never disclosed their confidential information or information of other residents to them. Interview with resident (R1) stated that they have overheard facility staff sharing their confidential information with others in the facility. LPA attempted to interview (2) additional residents in the facility but was unable as the residents English speaking capabilities were limited. There was not enough information or evidence present to corroborate this allegation; therefore, the allegation is unsubstantiated.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2