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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 06/20/2025
Date Signed: 06/20/2025 11:48:20 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
06/09/2025 and conducted by Evaluator Holly Williams
COMPLAINT CONTROL NUMBER: 27-AS-20250609092802
FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:WHITE, CHARLESFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 81DATE:
06/20/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lisa JohansenTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff refused to provide accommodations to resident in care
INVESTIGATION FINDINGS:
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On 6/20/25 Licensing Program Analysts (LPA) Holly Williams arrived unannounced to deliver findings on this complaint investigation. LPA met with the facility designated administrator (FDA) Business Office Manager Lisa Johansen who was briefly interviewed at this time. LPA called the interim administrator Brandon Collins and Collins gave permission for FDA to sign.
The purpose of this visit was to deliver the findings of this investigation to this facility, and it's representative, at this time. It is alleged that staff refused to provide accommodations to resident in care. During the course of the investigation, LPA reviewed records, interviewed staff members, and residents. In an interview, R1 stated that they wanted a certain part positioned where R1 was not in pain or medically compromised. R1 felt that S1 was not listening to R1. When speaking to R1 they stated that they did not want to file the complaint any longer and that R1 was getting frustrated at the time. S1 stated that S1 was trying to accommodate the resident. When speaking to both S1 and R1 they had talked, there was a communication issue, and both hugged each other and wanted to start over.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
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-20250609092802
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: 06/20/2025
NARRATIVE
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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.

Exit Interview
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2