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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 01/16/2025
Date Signed: 01/16/2025 02:26:52 PM

Substantiated


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
10/14/2024 and conducted by Evaluator Holly Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241014150651
FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:CRUZ, ALFREDOFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 86DATE:
01/16/2025
UNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Charles WhiteTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility accepts residents for care however the staff cannot meet their needs.
Facility staff yell at residents
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Holly Williams made an unannounced visit to conclude the investigation of the above allegations and to deliver the findings. LPAs Williams met with facility administrator Charles White and together discussed the investigation details.

This investigation consisted of interviews, observations. LPA Williams interviewed White, six staff members (S1-S6) and eight residents (R1-R9).
In an interview, R2 said they have heard staff members yelling at residents. In an interview, S3 stated that she has heard staff members yell "just sit down!" because they were frustrated. In an interview, R9 states that staff members yell at R all the time.
S1 said they had a client complain of overnight staff members have treated them residents badly. S3 stated that the facility is neglectful, and they do not treat the residents good. S3 said they are severely
[Continued on 809-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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-20241014150651
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
VISIT DATE: 01/16/2025
NARRATIVE
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short staffed and that S3 had to do a two person assist by herself because there was not enough staff to help. S3 stated that R7 was not liked by staff members and R7 was very vocal about what was wrong. S3 said that the staff members would leave R7 for long periods to be wiped and the staff members would take too long to respond to R7. S3 said that R8 was sitting out in the hallway waiting for her shower and R8 was there for like 2-3 hours and there was no staff around. S3 stated that R8 said I don’t know where they went. In an interview with S5 said that she does have R8 wait out in the hall in their nightgown and at times does get busy helping other residents. S3 stated that S3 finally just gave R8 a shower. In an interview, R3 said they keep skipping R3 for showers. R3 said R3 hasn't had a shower in a week. R3 stated that R3 pushes the button for help and staff members walk in turn the button back on and leave. In an interview, R7 and R5 have both complained about their beds that are broken and have not been fixed. R5 said R5’s bed will not recline or come back up and R7 states the safety bar is broken and there are holes in the foot board that are sharp and can hurt R7’s feet.
LPA Williams went into R4 and R5’s room to talk with R4 and it smelled strong of urine. LPA Williams and LPA Pang Lee observed in the shower room there was a bag of soiled linens and the whole shower smelled so strong we could not enter, and the exhaust fan was covered in dirt and dust, and it extended to the wall. The floors were not clean in all rooms we went in. On 1/16/25 when LPA Williams walked into the facility it smelled of urine.
Based on interviews the above allegations are SUBSTANTIATED, which means that the allegations are valid because the preponderance of the evidence standard has been met.
This facility is hereby cited per 22 CCR Sections 87468.1(a)(1), 87464.1(f)(1). An exit interview was conducted with White. A copy of this report and appeal rights were left with White.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20241014150651
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: APPLE RIDGE ASSISTED LIVING, LLC
FACILITY NUMBER: 342701251
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/17/2025
Section Cited
CCR
87468.1(a)(1)
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(a)(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement was not met as evidenced by:
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Licensee agrees to email a plan for training including date and times and subject matter. Once training is completed Licensee agrees to send sign in sheet to LPA Williams. Holly.Williams@dss.ca.gov
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Based on interviews personal relationships with staff are not handled with dignity which poses an immediate health, safety and/or personnel rights risk.
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Type A
01/17/2025
Section Cited
CCR
87464(f)(1)
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(f) Basic services shall at a minimum include:
(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).s This requirement was not met as evidenced by:
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Licensee agrees to email a plan for training including date and times and subject matter. Once training is completed Licensee agrees to send sign in sheet to LPA Williams. Holly.Williams@dss.ca.gov
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Based on observation and interview residents are not receiving the basic services that they need which poses an immediate health, safety and/or personnel rights risk.
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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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC9099 (FAS) - (06/04)
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