342701230-6-17-2026-27-AS-APAA-DVXR2H-20260713123822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701230
Report Date: 06/17/2026
Date Signed: 06/17/2026 03:03:07 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
05/15/2026 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20260515090756

FACILITY NAME:	SACRAMENTO SENIOR LIVING		FACILITY NUMBER:	342701230
ADMINISTRATOR:	LEWIS, SALOTE		FACILITY TYPE:	740
ADDRESS:	6825 BENDER CT		TELEPHONE:	(510) 710-5707
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95820
CAPACITY:	6	CENSUS: 6	DATE:	06/17/2026
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Salote Lewis		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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1) Staff are not meeting residents hygiene needs
2) Staff leave resident in soiled briefs for an extended period of time
3) Staff isolate resident in room

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection to Sacramento Senior Living RCFE on 6/17/26 at 2:20 to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with Licensee, Salote Lewis and together discussed the investigation details.

Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. LPA Gould conducted interviews with three residents and four caregivers, including the licensee/administrator. All staff members interviewed described consistent care plans for alleged victim including 1 hour checks for incontinence and daily showers due to the incontinence of the alleged victim. LPA has observed the alleged victim outside of their room, interacting with staff and other residents. LPA attempted to interview alleged victim but was not able to conduct an interview due to alleged victim being non-verbal. Other residents interviewed denied witnessing such incidents or provided statements that what was reported is no longer happening. LPA could not corroborate the allegation. Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20260515090756

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: SACRAMENTO SENIOR LIVING	FACILITY NUMBER: 342701230
	VISIT DATE: 06/17/2026

NARRATIVE

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Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of neglect/lack of supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies is cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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