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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701306
Report Date: 08/22/2025
Date Signed: 08/22/2025 11:42:07 AM

Unfounded


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
09/04/2024 and conducted by Evaluator Arvin Villanueva
COMPLAINT CONTROL NUMBER: 27-AS-20240904151144
FACILITY NAME:MEADOWS SENIOR LIVING, THEFACILITY NUMBER:
342701306
ADMINISTRATOR:SELLERS, ALYSSAFACILITY TYPE:
740
ADDRESS:9325 EAST STOCKTON BLVD.TELEPHONE:
(916) 877-7835
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:160CENSUS: 79DATE:
08/22/2025
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Kaushik Sharma, Business ManagerTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Questionable death
INVESTIGATION FINDINGS:
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On 8/22/2025, Licensing Program Analyst Arvin Villanueva (LPA) arrived unannounced at this facility to conduct a follow-up complaint visit regarding the allegation noted above. LPA met with Kaushik Sharma, Business Manager, and stated the purpose of the visit.

The investigation into the above allegation consisted of record reviews.

Through review of records, R2, a resident of this care facility, passed away on 8/13/2024 at approximately 0514 hours at a hospital Emergency Room. The death certificate lists coronary artery disease as the immediate cause of death, with hypertension as another significant condition. Other health conditions noted include urinary tract infection and sepsis, but none are indicated as the immediate cause of death. The certificate does not suggest any unusual circumstances contributing to R2’s passing.


{LIC9099-1}
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
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-20240904151144
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: MEADOWS SENIOR LIVING, THE
FACILITY NUMBER: 342701306
VISIT DATE: 08/22/2025
NARRATIVE
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Through review of facility records, R2 had been at this facility for five days and had known diagnoses of acute kidney failure and hypertensive heart disease. R2’s POLST documents indicate Do Not Resuscitate (DNR) orders and a focus on comfort care.

Further review of facility records from 8/8/2024 to 8/13/2024 shows that staff followed physician orders, appropriately managed medications, and provided care consistently with R2’s comfort-focused instructions.

Based on the information gathered, there is no found evidence to indicate that R2’s death was the result of neglect, mismanagement, or any questionable circumstances. Therefore, the allegation is UNFOUNDED.
Note that an unfounded finding means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Based on this investigation, no citations are issued. Exit interview was conducted and a copy of this report was provided.















{LIC9099-2}
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2