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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 04/08/2025
Date Signed: 04/08/2025 12:08:58 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
12/17/2024 and conducted by Evaluator Holly Williams
COMPLAINT CONTROL NUMBER: 27-AS-20241217132635
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: 87DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Brandon CollinsTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff are charging resident in excess of the rate allowed under the Medi-cal Assistance Program (ALW)
Staff did not accord resident privacy and interfered with resident's visit
Resident left the facility unattended due to lack of care or neglect from staff
Facility staff did not safeguard resident funds
INVESTIGATION FINDINGS:
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On 4/8/2025 Licensing Program Analyst (LPA) Holly Williams arrived unannounced to deliver findings on this complaint investigation. LPA Williams met with Regional Director of Operations Brandon Collins and explained the purpose of the visit.
This investigation consisted of record review and interviews with staff and residents. A brief interview was held with Brandon Collins.

Allegation: Resident left the facility unattended due to lack of care or neglect from staff.
It is alleged that the resident left the facility unattended. In an interview, R1 said R1 has never left the facility unattended. In an interview, Alfredo Cruz the prior administrator of Apple Ridge Assisted Living, LLC said that R1 never left the facility while Cruz was there R1 always had a staff member with R1 when leaving the facility. 3 out of 3 staff said that R1 has never left the facility without a staff member. Based on interviews and record review it is unclear if R1 left the facility unattended.

[Continue on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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-20241217132635
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: 04/08/2025
NARRATIVE
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Allegation: Staff did not accord resident privacy and interfered with resident's visit.
It was alleged that staff did not accord resident privacy and interfered with resident visit. During the course of the investigation, LPA interviewed R1, R1 stated that R1’s privacy was not compromised on the visit. R1 stated that it was a resident who was trying to help and R1 wanted the resident to help. Staff members were not aware of this incident. Based on an interview with the resident it is unclear that the staff did not accord resident privacy and interfered with the resident’s visit.

Allegation: Staff are charging resident more than the rate allowed under the Medi-Cal Assistance Program (ALW)
It was alleged that staff charged more than the allowed rate under the Medi-Cal Assistance Program (ALW) During the course of the investigation, LPA Williams went through the ledger in the month of December 2024 and R1 was not charged 2 times for rent. The payment was reversed because there was not enough money in the account. LPA Williams obtained a document from Department of Social Services showing that the allowable rate raised to $1420.07. Based on interview and record review it is clear that R1 was not over charged.

Allegation: Facility staff did not safeguard resident funds.
It was alleged that staff did not safeguard resident’s funds. During the course of this investigation, LPA interviewed staff, residents, and reviewed records. Based on interviews, R1 said that R1 refused to let anyone manage R1’s money. According to the physician’s assessment LIC 602 it states that R1 cannot handle R1’s own money. According to the pre appraisal, it states that R1 is managing his own money. In an interview, S1 stated that R1 refused to let the facility handle R1’s money. R1 let another resident have his debit card and the pin and money was stolen. A police report was filed. R1 now has a card file and anyone that goes with R1 to the store must record it and include the receipts. Based on interviews and record review it is unclear that staff did not safeguard resident funds.

Based on interviews, observation, and record review, the above allegation is UNSUBSTANTIATED, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
No deficiencies were cited regarding the above allegation. An exit interview was held, and a copy of this report was left with Brandon Collins.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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