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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701306
Report Date: 07/02/2026
Date Signed: 07/02/2026 04:20:39 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
03/25/2026 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20260325122154
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: 90DATE:
07/02/2026
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Alyssa SellersTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to a resident
Staff did not administer medications to resident
INVESTIGATION FINDINGS:
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On 7-2-2026 at 2:59pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegations noted above. LPA met with Administrator Alyssa Sellers and explained the purpose of the visit. During this investigation, LPA conducted interviews with five staff members and reviewed facility file documentation including progress notes regarding resident1 (R1), medication log sheets regarding R2, census report, pull cord and pendent log reports, physician’s reports for R1 and R2, appraisals for R1 and R2, needs and service plan for R2, and video recording.

Allegation: Staff did not provide adequate supervision for a resident. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was revealed that on 2-10-2026 R1 was noted on the floor by staff with wheelchair over her and thighs under the legs of the wheelchair. R1 was examined by a hospice nurse which did not reveal injuries or complaints of pain. A review of pendent log revealed that on 2-10-2026 at 5:52pm R1 pushed pendant to request assistance {Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
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)
Page: 1 of 3
Control Number 27-AS-20260325122154
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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 Report does not indicate location where R1 was at the time. The report further revealed that pendant of R1 was responded to by staff at 6:41pm indicating a wait time of 48 minutes and 52 seconds. Based on review of video recording it was revealed that R1 fell out of her wheelchair near her bed at 6:35pm during an attempted self transfer with wheelchair appearing to be partially on top of R1. A second video revealed a caregiver entering the room at 6:43pm to begin assessing R1 after noticing R1 on the ground. Interviews conducted further confirmed a wait time of approximately 48 minutes. A review of R1’s physician’s report and appraisal form indicated R1 experienced disorientation and required assistance for activities of daily living including incontinence care and was under hospice care at the time of the above incident. Based on the above evidence reviewed, it is determined that staff did not provide adequate supervision for R1 on 2-10-2026. The preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Allegation: Staff did not administer medications to a resident. LPA conducted interviews and record reviews as noted above. Record reviews revealed a self-medication management acknowledgement was signed by R2’s responsible person and Administrator to indicate R2 can manage own medication. A physician’s report for R2 dated 1-23-2026 stated R2 is unable to manage own medication and required assistance. A census report indicated R2 was in a hospital setting and not at the facility from the dates of 1-9-2026 to 1-29-2026. Based on review of medication log sheet for January 2026 it was indicated that R2 did not receive four medications as ordered between the dates of 1-30-2026 and 1-31-2026. Interviews conducted further confirmed the information revealed in the log sheets. No additional evidence existed which proved R2 ever received these medications. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.
Citations are issued under Title 22, Division 6, and Health and Safety Code, Chapter 3.2, and noted on LIC 9099D. An exit interview was conducted with Administrator, and a copy of this report was provided. LIC 811 and appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
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)
Page: 2 of 3
Control Number 27-AS-20260325122154
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2026
Section Cited
HSC
1569.312(e)
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H&S Code Section 1569.312(e) Basic Services Requirements. (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement was not met as evidenced by:
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Licensee will ensure completed staff training on proper and timely response to call buttons. Training date to be submitted to LPA by POC due date. Proof of completed training to be sent to LPA by 7/16/2026.
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Based on interviews and record reviews, licensee did not ensure the proper and timely monitoring and supervision of R1. This posed an immediate health and safety risk to resident in care.
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Licensee will submit a plan outlining procedures for proper and timely answering of call buttons and other requests for resident assistance. Plan to be submitted to LPA by POC due date.
Type A
07/03/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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Licensee will ensure completed staff training on medication handling and procedures. Training date to be submitted to LPA by POC due date. Proof of completed training to be sent to LPA by 7-16-2026.
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Based on interview and record review, Licensee did not ensure the assistance of four self-administered medications for R2. This posed an immediate health and safety risk to resident 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: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3