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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 01/16/2026
Date Signed: 01/16/2026 10:58:29 AM

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
11/04/2025 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251104005226
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: 83DATE:
01/16/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ilona CorpusTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff did not notify resident's responsible party of a change in resident's condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced complaint inspection with the above facility on January 16, 2025, at 10:30 AM and met with Ilona Corpus. The purpose of the inspection was to deliver complaint findings for the above allegation.

During this investigation, LPA Martinez conducted confidential interviews and reviewed records. During the investigation, LPA Martinez obtained two care plans for resident 1 (R1). One care plan (Service Plan) was completed by facility staff on November 23, 2024, and was signed by R1's responsible party. The second care plan (assessment tool) was completed by a third-party social worker. The information on the assessment tool was obtained from R1 and the facility wellness director. This assessment tool was not signed by R1’s responsible party.

Continued...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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 5
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
11/04/2025 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251104005226

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: 83DATE:
01/16/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ilona CorpusTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff did not shower a resident in care.
Staff left resident in a soiled brief for a long period of time.
Staff did not prevent facility from being malodorous.
Staff did not keep facility free of insects.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced complaint inspection with the above facility on January 16, 2025, at 10:30 AM and met with Ilona Corpus. The purpose of the inspection was to deliver complaint findings for the above allegations.

Based on interviews conducted and records reviewed, it was determined that there was not sufficient evidence to show resident 1 (R1) was not showered as required and left left in a soiled brief. When interviewed, R1 reported they received adequate care while living at this facility. R1 reported they had no issue or concerns in regard to the staff or the care that they were receiving at this facility. Facility care notes also indicated R1 had a history of being non-complaint with their care. Additionally, facility notes state R1 had a history of refusing showers.

Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20251104005226
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: 01/16/2026
NARRATIVE
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In addition, LPA Martinez toured the facility on October 27, 2025; November 06, 2025; and December 22, 2025. LPA Martinez did not observe pest. The facility has a pest control company that conducts pest treatments regularly. During the above stated tours, the facility was not malodorous. LPA Martinez also reviewed the cleaning schedule, which shows cleaning of the facility is done daily.

Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 27-AS-20251104005226
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: 01/16/2026
NARRATIVE
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The June 11, 2025 tool assessment indicated R1's had a decline in physical functioning. It was also noted facility staff were concerned due to R1's increased depression and decreased appetite. The tool assessment also indicated R1 had scabs on their face and nose, and was declining to visit their primary care physician in person.

After the June 11, 2025, tool assessment was completed, facility staff did not update the November 23, 2024 service plan. Additionally, there are no facility notes that indicated facility staff informed R1's responsible party that R1 had a change in condition.

As a result of this investigation, the Department finds this 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. Deficiency cited on the LIC 9099-D page, per Title 22 Regulations. An exit interview was conducted, and a copy of this LIC 9099 report, LIC 9099-D page, and LIC appeal rights document were provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20251104005226
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: 01/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/29/2026
Section Cited
CCR
87466
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 87466 Observation of the Resident
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning... when such observation reveals unmet needs...the licensee shall ensure that suchchanges are documented and brought to
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Facility staff agrees to will conduct an in-service training on assessments by 01/29/26. Facility staff will email training documents to LPA Martinez by 01/29/26 5:00 PM.
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 the attention of the resident's physician and the resident's responsible person... This requirement was not met as evidence by. Based on file review /interviews, the Licensee did not ensure R1's change in condition was documented on service plan and communicated to R1's responsible party. This posed a potential health and safety risk to R1.
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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: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5