342701317-7-20-2026-27-AS-APAA-DWANGC-20260724102656

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701317
Report Date: 07/20/2026
Date Signed: 07/20/2026 02:32:38 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
05/22/2026 and conducted by Evaluator Shakaricka Hughes

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260522131940

FACILITY NAME:	TAMBOR HOME		FACILITY NUMBER:	342701317
ADMINISTRATOR:	VERGARA, RICHARD CARLSON		FACILITY TYPE:	735
ADDRESS:	8458 TAMBOR WAY		TELEPHONE:	(510) 825-5851
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	3	CENSUS: 2	DATE:	07/20/2026
		UNANNOUNCED	TIME BEGAN:	02:17 PM
MET WITH:	Administrator: Richard Vergara		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff do not provide a safe environment for residents

INVESTIGATION FINDINGS:

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On 07/20/2026,, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the administrator Richard and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 2.

Allegation: Staff do not provide a safe environment for residents
It was alleged that staff do not provide a safe environment for residents. This investigation consisted of interviews with facility staff and records review. On 05/27/2026, LPA Hughes conducted a visit to the facility and interviewed the facility administrator who stated that client (C1) disclosed not feel safe residing at the facility due to a conflict with another client (C2), has repeatedly AWOL’ d, and refused to return despite multiple discussions and attempts to encourage the client to come back. The administrator stated client (C1) wanted to relocate in order to return to their previous school placement. Further stating, staff had implemented intervention strategies, including staff training and separating the clients, but the client continued to report feeling unsafe.

Continuation 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

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-20260522131940

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: TAMBOR HOME	FACILITY NUMBER: 342701317
	VISIT DATE: 07/20/2026

NARRATIVE

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LPA interviewed facility staff (S1) who stated they (C1) had never disclosed to them that they felt unsafe inside the facility, further stating that they did not observe any conflicts or on-going issues between residents in the facility. LPA attempted to interview client (C1) but was unable as the resident was removed from the facility. LPA reviewed C1’s records, including the LIC 602 Physician’s Report, and Individual Program Plan (IPP), and facility sign-out sheets. Records indicated C1 was able to leave the facility unassisted and had a history of elopement behaviors. The IPP documented interventions, including the use of a sign-in/sign-out sheet and contacting law enforcement when appropriate. There is not enough evidence or information present to corroborate this allegation, therefore the allegation is unsubstantiated.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC9099 (FAS) - (06/04)

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