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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701241
Report Date: 09/18/2025
Date Signed: 09/18/2025 11:23:24 AM

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
09/10/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250910132943
FACILITY NAME:BUEN VIAJE RESIDENCEFACILITY NUMBER:
342701241
ADMINISTRATOR:BUENVIAJE, SHERINIEFACILITY TYPE:
735
ADDRESS:3419 KLEVNER WAYTELEPHONE:
(818) 631-4890
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY:4CENSUS: 4DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
07:49 AM
MET WITH:Sherinie BuenviajeTIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Staff member was under the influence of substances while providing care and supervision to residents in care.
Staff member did not ensure that resident was adequately fed while in care.
Staff member did not ensure that resident was provided with clean bedding while in care.
Staff member did not ensure that resident was administered their medication according to physician's instructions.
Staff member did not adequately supervise resident(s) in care.
INVESTIGATION FINDINGS:
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On 09/18/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Sherinie Buenviaje and explained the purpose of the visit. The purpose of this visit was to inform the facility and its representative that a complaint has been filed against it at this time.
Current census was 4. A brief interview with FDA Buenviaje was conducted.
Allegation: Staff member was under the influence of substances while providing care and supervision to residents in care.
It was alleged that the facility staff member was under the influence of substances while providing care and supervision to residents in care. During the course of this investigation LPA conducted interviews, reviewed records, and conducted observations. Based on interviews conducted with 4 staff members, 4 out 4 staff members denied that the facility staff member was under the influence of any substances while providing care. 4 out 4 staff members state that they only witness staff members smoking cigarettes in the designated smoking area.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 3
Control Number 27-AS-20250910132943
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: BUEN VIAJE RESIDENCE
FACILITY NUMBER: 342701241
VISIT DATE: 09/18/2025
NARRATIVE
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In addition, 4 out 4 staff members deny that they have been under the influence while caring for residents. Based on the information gathered, there is not sufficient evidence to show that the facility staff is under the influence while providing care.

Allegation: Staff member did not ensure that resident was adequately fed while in care.
It was alleged that facility staff did not ensure that resident was adequately fed while in care. During the course of this investigation, LPA conducted interviews, reviewed records and conducted observations. Based on interviews conducted, it was 4 out 4 staff members deny that the resident was adequately fed while in care. 4 out 4 staff members state that they will provide assistance to residents as needed. 4 out 4 staff members stated that most residents are able to feed themselves and deny seeing any other staff members not feeding residents in care. Residents interviewed also stated that they are able to eat what they want and have access to the kitchen area. Based on the information gathered, there is not sufficient evidence to prove that the staff member did not ensure that resident was adequately fed while in care.

Allegation: Staff member did not ensure that resident was provided with clean bedding while in care.
It was alleged that facility staff did not ensure that resident was provided with clean bedding while in care. During the course of this investigation, LPA conducted interviews and conducted observations. Based on interviews conducted, it was learned that facility staff is expected to clean resident bedding as needed. Facility staff state that they clean the bedding at least once a week, however, due to the care needs of each resident it may be hourly. In addition, LPA conducted a tour of 4 resident bedrooms. All bedrooms were observed with clean bedding. Based on the information gathered, there is not sufficient evidence to provide that the staff member did not ensure that the resident was provided with clean bedding while in care.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250910132943
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: BUEN VIAJE RESIDENCE
FACILITY NUMBER: 342701241
VISIT DATE: 09/18/2025
NARRATIVE
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Allegation: Staff member did not ensure that resident was administered their medication according to physician's instructions.

It was alleged that staff member did not ensure that resident was administered their medication according to physicians instructions. Based on interviews conducted, 4 out 4 staff members deny that medication was not administered as physicians instructions. LPA conducted a review of the medication administration record to medication on site. There was no indication that the facility staff does not administer medication according to the physicians order. Based on the information gathered, there is not sufficient evidence that the facility staff did not ensure that resident was administered their medication according to physicians instructions.

Allegation: Staff member did not adequately supervise resident(s) in care.
It was alleged that the staff member did not adequately supervise residents in care. Based on interviews conducted, 4 out 4 staff members deny that the staff do not adequately supervise resident in care. In addition, 4 out 4 staff members state that if they need additional support they ask for additional assistance from other care staff. In addition, LPA Pascua conducted observations during the course of the visit conducted on 09/18/2025. All residents were observed to be supervised during the course of this visit. Based on the information gathered, there is not sufficient evidence to provide that the staff member did not adequately supervise resident(s) in care.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3