342701306-7-2-2026-27-AS-SRIN-DVUUN4-20260710154320

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701306
Report Date: 07/02/2026
Date Signed: 07/02/2026 05:43:45 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
06/30/2026 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20260630084535

FACILITY NAME:	MEADOWS SENIOR LIVING, THE		FACILITY NUMBER:	342701306
ADMINISTRATOR:	SELLERS, ALYSSA		FACILITY TYPE:	740
ADDRESS:	9325 EAST STOCKTON BLVD.		TELEPHONE:	(916) 877-7835
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	160	CENSUS: 90	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Alysa Sellers, Executive Director		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Staff did not ensure that the resident’s specialized care needs were met at the facility.

INVESTIGATION FINDINGS:

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On 07/02/26, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator/Executive Director. LPA met with Alyssa Sellers and a brief interview followed.

The following documents were requested for resident (R1):
Admission Agreement
LIC 602
Appraisal/Reappraisal and Care Plan
Incident report for 911 call
Staff names and phone numbers for 6/27/26
Call lights/pendant logs for 6/26/26 through 06/27/26
Review of Medication Record for June 2026

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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-20260630084535

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: 07/02/2026

NARRATIVE

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Caregiver assignment sheet for R1

During this visit, this LPA interviewed the resident (R1) and 3 staff (S1, S2 and S3). This LPA also reviewed the records requested above.

Based on a review of records, in the resident's (R1's) service plan, R1 was independent and did not need assistance with their special medical needs. Due to R1's complicated medical condition, an event occurred which resulted in R1 activating their personal call alert pendant. Staff (S2) responded within 4 minutes and S1 arrived shortly after.

R1 was on the phone with emergency services when S2 arrived. S1, a medication aide, had received a call from emergency services alerting them to the fact that a resident had called for transport due to shortness of breath. When S1 arrived in the R1's room, they observed that R1's medical equipment had detached from their body and as The Meadows is not a skilled nursing facility, by regulations, they were not allowed, trained, or qualified, to assist the resident with re-establishing the connection. It was appropriate for the resident to call 911. If the resident had not called, S1 or S2 would have been required to do so as their Wellness Director, an. LVN, was not on duty that weekend.

R1's service plan stated that they (and their special medical equipment) would receive checks 3 times daily. LPA reviewed the log which was completed for all of the required checks. In an interview with R1, R1 stated that they were at fault for waiting too long to call for assistance which caused the event that required emergency services to intervene.

The standard for the preponderance of evidence has been met, the Department found the allegation,
"Staff did not ensure that the resident’s specialized care needs were met at the facility," UNSUBSTANTIATED. A finding of unsubstantiated does not mean the event did not happen or was untrue, it means that there was not enough evidence to substantiate the allegation.

According to the California Code of Regulations, Title 22, no deficiencies were cited during today's visit, a copy of this report was provided along with APPEAL RIGHTS, and an exit interview was conducted with Sellers.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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