342701251-7-1-2026-27-AS-LRIS-DVUQ6X-20260710115416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701251
Report Date: 07/01/2026
Date Signed: 07/01/2026 10:58:39 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
03/18/2026 and conducted by Evaluator Albert Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260318141417

FACILITY NAME:	SIERRA LOMA ASSISTED LIVING		FACILITY NUMBER:	342701251
ADMINISTRATOR:	ILONA CORPUS		FACILITY TYPE:	740
ADDRESS:	3950 ANNADALE LANE		TELEPHONE:	(916) 489-6900
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95821
CAPACITY:	94	CENSUS: 70	DATE:	07/01/2026
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Kyle Riley (Director of Nursing) DON		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff did not allow resident back into the facility

INVESTIGATION FINDINGS:

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On 7/1/2026, Licensing Program Analyst (LPA) Johnson conducted an investigation regarding concerns that the facility failed to allow R1 did not allow resident back into the facility.

LPA interviewed Kyle Riley (S1) and reviewed available facility records. It was observed in notes that former RCC (Resident Care Coordinator) Mitchell reported that R1 expressed a desire to transfer to a skilled nursing facility (SNF) to receive physical therapy (PT) and occupational therapy (OT). S2 confirmed that the decision to pursue skilled nursing was R1’s choice, and that R1 wanted additional therapy services at the time. S2 stated R1 had returned to his baseline functioning and did meet criteria for continued skilled nursing placement.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20260318141417

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: SIERRA LOMA ASSISTED LIVING	FACILITY NUMBER: 342701251
	VISIT DATE: 07/01/2026

NARRATIVE

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LPA obtain medical records from the post acute hospital and Fair Oaks Care Center; however, no records were available from the time of R1’s stay. S2 reported that Fair Oaks was the third SNF R1 had been referred to during that period due to insurance complications.

Regarding the facility evaluation, RCC Mitchell stated that former RCC Hakim was expected to complete an assessment for R1’s return, but there is no documentation indicating that Hakim conducted or submitted an evaluation. S2 stated the evaluation was intended to determine whether R1 could safely return to the facility. S2 reported R1 required two person assistance at the time and did not qualify for a hospital bed through insurance. R1 reportedly already had a hospital bed available elsewhere but did not want a twin sized bed. S2 also stated they were not familiar with restricted or prohibited health conditions and were unsure what requirements applied to R1’s return.

Based on interviews and available information, there is no evidence that the facility refused R1’s return, failed to coordinate care, or violated Title 22 requirements. The information gathered indicates R1 independently pursued skilled nursing services, and information reviewed confirmed the need for a higher level of care. Therefore, the allegation is unsubstantiated.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

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