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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 09/04/2025
Date Signed: 09/04/2025 03:31:28 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
01/28/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250128120542
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: 82DATE:
09/04/2025
UNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:IIlona CorpusTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not meeting residents’ needs resulting in injuries
INVESTIGATION FINDINGS:
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On 09/04/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at this facility to conduct a complaint visit. LPA met with facility designated administrator (FDA) Ilona Corpus and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. The current census is 79. A brief interview conducted with FDA Corpus.

It was alleged staff are not meeting residents needs resulting in pressure injuries. During the investigation, the Licensing Program Analyst (LPA) interviewed staff and residents and reviewed relevant records. Based on these interviews it was learned that 7 out of 7 staff members have not seen any pressure injuries to residents in care. Moreover, R1 stated that the staff members have been changing R1 on time. R2 stated that they are dry and changed on time.

LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
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 8
Control Number 27-AS-20250128120542
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: 09/04/2025
NARRATIVE
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On 01/31/2025, LPA Renee Campbell went out to the facility to open the complaint and interviewed 4 residents, and all 4 residents stated they did not have pressure injuries and while observing staff cleaning residents after experiencing incontinence, no sores or wounds were observed but there were areas of redness. On 02/13/2025, 04/21/2025 and 04/22/2025, LPA Holly Williams also went out to the facility to follow-up on the complaint and interviewed both residents and facility staff and there were no residents in care with pressure injuries. On 07/10/2025, LPA Pang Lee visit the facility to follow-up on the allegation and based on interview with, residents, facility staff there were no residents with pressure injuries. Based on records, review R1 has a history of skin breakdown and is placed on hospice. Based on the information, there is not a preponderance of the evidence to substantiate this allegation.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
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
01/28/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250128120542

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: 82DATE:
09/04/2025
UNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:IIlona CorpusTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
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9
Staff are not using two-person assists for residents
Staff are not ensuring residents’ rooms are kept clean
Staff are not meeting residents’ laundry needs
INVESTIGATION FINDINGS:
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On 09/04/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at this facility to conduct a complaint visit. LPA met with facility designated administrator (FDA) Ilona Corpus and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the above allegations. The current census is 82. A brief interview conducted with FDA Corpus.

It was alleged that staff are not using two-person assist for residents. During the investigation, the Licensing Program Analyst (LPA) interviewed staff and residents and reviewed relevant records. Of the seven staff members interviewed, six reported that they typically use one-person assistance for transfers due to staffing shortages. Additionally, nine out of eleven residents confirmed that staff often use only one person to assist them during transfers from bed to wheelchair or vice versa. Resident R4’s Needs and Services Plan specifies a two-person assist.

CONTINUED LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 27-AS-20250128120542
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: 09/04/2025
NARRATIVE
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However, resident 1 (R1) R1 stated that staff sometimes use only one person to assist with transfers. R1’s Needs and Services Plan states two-person assistance with toileting and transfer and according to the medical assessment R1 is bedridden. Moreover, R1 reported that staff rarely use the Hoyer lift and instead one staff will lift them manually by swinging their legs over the bed and transferring them into a wheelchair. According to the facility’s Plan of Operation it states the following: The licensee shall ensure that there is an adequate number of caregivers to support each resident's physical, social, emotional, safety and health care needs as identified in his/her current appraisal. If any resident requires two staff members to assist or transfer a resident or for any other reason, adequate staff shall be on hand to assist the resident. Based on the information gathered, there is a preponderance of evidence to substantiate the allegation.

It was alleged that staff are not ensuring that residents’ rooms are kept clean. During the investigation, Licensing Program Analyst (LPA) conducted interviews with both residents and staff and made direct observations during facility visits. Based on interviews, it was revealed that seven out of ten residents do not have a laundry hamper in their rooms, resulting in residents placing dirty clothes on the floor, often in the corners of their rooms. Additionally, 13 out of 14 staff members confirmed that residents do not have hampers and store dirty clothing on the floor. During LPA Williams' facility visits on February 13, 2025, and April 21, 2025, the following conditions were observed in residents' rooms:

· Showers with dirty towels on the floor

· Food found on a resident's pillow

· Dirty sheets on the shower floor

· Closets containing soiled clothing with a strong urine odor

· Piles of dirty clothes in corners of rooms

· Rooms containing food, urinals, and clothing in the same area

CONTINUED LIC 9099-C

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 27-AS-20250128120542
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: 09/04/2025
NARRATIVE
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· Food placed next to urinals

· Old food and garbage, including containers and cups, left in the rooms

· Soiled towels and sheets on the floor

· Cluttered living conditions

· Old pizza boxes left in residents’ rooms

During another visit conducted by LPA Lee on 07/10/2025, LPA Lee observed two residents’ rooms had a strong incontinence smell. According to the facility’s Plan of Operation, caregiver duties include “maintaining the facility in a neat, safe, and sanitary condition.” Based on the information obtained through interviews and direct observations, there is a preponderance of the evidence to substantiate the allegation that staff are not ensuring residents room are kept clean.

It was alleged that staff are not meeting residents’ laundry needs.

During the investigation, Licensing Program Analyst (LPA) Holly Williams conducted interviews with residents and staff and made direct observations during multiple facility visits. Of the seven staff members interviewed all seven reported that the facility’s laundry services need improvement. They stated that residents’ clothing is not labeled, which frequently results in laundry being lost or mixed up. Staff also reported that the laundry room doors are often left open and accessible to residents, further increasing the risk of clothing being misplaced. Interviews with residents revealed that 13 out of 14 residents reported missing articles of clothing after the laundry is returned. Additionally, the residents do not have laundry hampers in their rooms to keep their clothing together or labeled, further contributing to laundry mix-ups. During LPA Williams’ visits to the facility on February 13, April 21, and April 22, 2025, the laundry room door was observed to be left open on each occasion. LPA Williams also observed that multiple residents’ rooms did not contain hampers, and dirty clothing was seen placed on the floor in the corners of the rooms not collected for wash.

CONTINUED LIC 9099-C

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 27-AS-20250128120542
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: 09/04/2025
NARRATIVE
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Additionally, in one resident’s room, dirty clothes were observed on the floor of the closet, with a strong odor of urine. According to the facility’s Plan of Operation, staff are required to: “Perform resident laundry service to include: 1. Strip bedding and replace. 2. Wash and return all clothes, linen and towels within 24 hours.” Based on staff and resident interviews, as well as direct observations, there is a preponderance of the evidence to substantiate the allegation that the facility is not meeting residents’ laundry needs.

Due to this investigation, the Department finds the allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with administrator Corpus and a copy of the LIC 9099 report, LIC 9099-D, and appeal rights were given to the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 27-AS-20250128120542
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: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2025
Section Cited
CCR
87464(d)
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87464(d) Basic Services:
(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.
This requirement was not met as evidenced by:
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The administrator will conduct staff training in basic service to include two-person assist. Training materials used for the training, staff sign in sheet for the
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Based on statements obtained from residents, facility staff and records review indicated the facility did not provide 2-person assistance to meet the resident's needs per their physician report and residents’ assessment plan. which poses a potential health, safety and personal rights risk to residents in care.
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training and a statement of acknowledgement of understanding the regulation cited will be provided to LPA Lee by POC date 09/17/2025 end of day 5:00 PM.
Type B
09/17/2025
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times.

This requirement was not met as evidenced by:
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The administrator will conduct staff training in maintenance and operation to ensure that the facility is clean and sanitary for all residents in care. Training materials used for the training,
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Based on statements obtained from residents, facility staff and observation the facility staff did not ensure that the facility was in clean and sanitary condition, which poses a potential health, safety and personal rights risk to residents in care.
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staff sign in sheet for the training and a statement of acknowledgement of understanding the regulation cited will be provided to LPA Lee by POC date 09/17/2025 end of day 5:00 PM.
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: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 27-AS-20250128120542
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: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2025
Section Cited
CCR
87307(a)(3)(F)
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87307 Personal Accommodations and Services
(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodation and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:
(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:
(F) Basic laundry service (washing, drying, and ironing of personal clothing).
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The administrator will conduct staff training for personal accommodation and services to laundry services and ensure that residents’ clothing is returned. Training materials used for the training, staff sign in sheet for the training and a statement of acknowledgement of understanding the regulation cited will be provided to LPA Lee by POC date 09/17/2025 end of day 5:00 PM.
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This requirement was not met as evidenced by:
Based on statements obtained from residents, facility staff, records review and observation, the facility did not meet residents’ laundry needs by ensuring that resident laundry was being done and ensuring that residents laundry are returned to the residents.
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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: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8