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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 12/02/2025
Date Signed: 12/02/2025 02:22:10 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
10/01/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251001145547
FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:ILONA CORPUSFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 80DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Ilona CorpusTIME COMPLETED:
12:56 PM
ALLEGATION(S):
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Staff did not respond to resident's call button in a timely manner
Staff do not serve resident food of good quality
INVESTIGATION FINDINGS:
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On 12/02/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Executive Director 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 80. A brief interview was conducted with Executive Director, Corpus.

It was alleged that staff did not respond to resident’s call button in a timely manner. The investigation included staff and resident interviews, a review of facility records, and direct observations. During interviews, 3 out of 5 staff members reported that adding one extra staff member per hall would help prevent delays in meeting residents’ needs. Additionally, 5 out of 7 residents stated that there are not enough staff available, particularly when responding to pendant call requests and getting their incontinence brief change.

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

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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 6
Control Number 27-AS-20251001145547
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: 12/02/2025
NARRATIVE
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 Residents reported waiting from 30 minutes to several hours to be changed out of their soiled incontinence briefs. Moreover, according to R1’s LIC 602 Physician’s Report dated 09/02/2025, R1 requires assistance with toileting. A review of the facility’s “Past Events” call log showed response times ranging from approximately 30 minutes to three hours. Residents expressed that staff often take a long time to respond or, at times, do not respond at all when the pendant is pressed. Some residents reported leaving their rooms to find staff because their calls went unanswered. During an unannounced visit on 10/03/2025, LPA interviewed two residents, (R1 and R2) who expressed concerns about delayed incontinence care. On the same day, the LPA observed two residents press their call pendants and wait approximately 30 minutes without a staff response. While waiting, the LPA observed two care staff and two med-techs walking past the residents’ rooms, unaware of the pending calls. LPA Lee then notified the Executive Director, Ilona, regarding the residents who had been waiting. LPA confirmed that the call alerts appeared on the monitor at the front desk; however, there was no audible alert unless staff visually noticed the calls on the screen. Additionally, during multiple unannounced visits, LPA noted strong incontinence odors throughout the facility. Based on the statement conducted, records reviewed and observation during the investigation process LPA Lee was able to corroborate the allegation; therefore, the allegation that licensee does not ensure that there are enough staff to meet the needs of residents in care is found substantiated.

It was alleged that staff did not serve residents with food of good quality. The investigation included staff and resident interviews as well as direct observations. During interviews, 5 out of 5 staff members stated they were not aware of any residents experiencing food poisoning and denied the allegation. However, 5 out of 7 residents reported dissatisfaction with the quality of the food served, stating that meals were often cold and lacked flavor. During an unannounced visit to the facility on 10/03/2025, LPA observed during a kitchen tour of improper food handling practices. Seven kitchen staff members were observed preparing lunch without wearing required hairnets. LPA Lee also observed a white bucket in the kitchen sink containing three large portions of ground beef submerged in running water to thaw for dinner. LPA also observed another white bucket filled with chicken breast on the counter and was informed that it had been taken out to thaw. In addition, several open food items were stored in the refrigerator without proper labeling, including cube peaches, apricots, and slice pickles, which were covered with plastic wrap but had no label for open dates and expiration dates. Based on the statement conducted and observation during the investigation process LPA Lee was able to corroborate the allegation; therefore, the allegation that staff do not serve resident food of good quality is found substantiated.
CONTINUED LIC 9099-C
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20251001145547
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: 12/02/2025
NARRATIVE
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As a result, this allegations are SUBSTANTIATED. The finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. The deficiency related to staff not responding to residents’ call buttons in a timely manner was not cited, as the citation was previously cited on 11/25/2025 under complaint control #27-AS-20250507151513. A deficiency that staff did not serve residents with food of good quality is cited on LIC 9099-D in accordance with Title 22 regulations. An exit interview was conducted with Executive Director Corpus, and copies of the LIC 9099, LIC 9099-D, and appeal rights were provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20251001145547
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: 12/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2025
Section Cited
CCR
87555(b)(15)
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87555(b)(15) General Food Service Requirements
(b) The following food service requirements shall apply:
(15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination.
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The administrator agrees to conduct general food service requirements and provide LPA Lee with staff training materials used and staff sign in and out sheets. POC due by 12/12/2025 end of day 5:00 PM.

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This requirement was not met as evidenced by:
Based on interviews and observation, the facility did not ensure that residents are provided with food of good quality. This poses an immediate health and safety risk for person in care.
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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: 12/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
10/01/2025 and conducted by Evaluator Pang Lee
COMPLAINT CONTROL NUMBER: 27-AS-20251001145547

FACILITY NAME:APPLE RIDGE ASSISTED LIVING, LLCFACILITY NUMBER:
342701251
ADMINISTRATOR:ILONA CORPUSFACILITY TYPE:
740
ADDRESS:3950 ANNADALE LANETELEPHONE:
(916) 489-6900
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:94CENSUS: 80DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Ilona CorpusTIME COMPLETED:
12:56 PM
ALLEGATION(S):
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2
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Staff did not assist resident with obtaining medical care in a timely manner
INVESTIGATION FINDINGS:
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On 12/02/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Executive Director 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 80. A brief interview was conducted with Executive Director, Corpus.

It was alleged that staff did not assist a resident with obtaining medical care in a timely manner. The investigation included staff and resident interviews as well as a review of facility records. All five staff members interviewed denied they were not providing timely assistance with medical care. Additionally, 6 out of 7 residents reported no concerns regarding obtaining their medical needs in a timely manner. Based on record review and interview statements, it was learned that Resident 3 (R3) had a fall while attempting to get out of bed and transfer into their wheelchair.

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

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20251001145547
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: 12/02/2025
NARRATIVE
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R3’s service plan indicates that they require standby assistance for transfers; however, during the interview, R3 stated they did not press their call pendant to request assistance prior to attempting the transfer and did so only after the fall occurred. Following the incident, R3 was transported to the hospital for further evaluation and care. Based on records review and statement conducted during the investigation process LPA Lee was unable to corroborate the allegation.

The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is unsubstantiated 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.

An exit interview was conducted with Executive Director, Corpus, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6