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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701325
Report Date: 03/05/2026
Date Signed: 03/05/2026 01:24:50 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
11/20/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20251120153406
FACILITY NAME:CHERISHED CARE HOME LLCFACILITY NUMBER:
342701325
ADMINISTRATOR:OMATSEYE, TOGHARANROSE ADAFACILITY TYPE:
735
ADDRESS:9268 CHAROLAIS WAYTELEPHONE:
(916) 868-2112
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 0DATE:
03/05/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ada OmatseyeTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility is out of ratio
INVESTIGATION FINDINGS:
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On 3-5-2026 at 12:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived to deliver and discuss findings for the allegation noted above. LPA met with Administrator Ada Omatseye and explained the purpose of the visit. During the course of this investigation, LPA conducted interviews with Administrator, and reviewed facility file documentation including physician’s report and individual program plan (IPP) for resident1 (R1). Additionally, a facility observation was conducted by LPA Hayes on 11-25-2025.
Allegation: Facility is out of ratio. LPA conducted interviews and record reviews as noted above. Based on interviews conducted and record reviews, it was revealed that on or about 11-20-2025, R1 was residing at the facility and was required to have a 2:1 staffing ratio. On this day, a scheduled staff member left the facility to attend to a personal matter leaving one staff member to supervise R1. It was further revealed that this staff member left facility prior to a replacement staff member arriving. {Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
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 5
Control Number 27-AS-20251120153406
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: CHERISHED CARE HOME LLC
FACILITY NUMBER: 342701325
VISIT DATE: 03/05/2026
NARRATIVE
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As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6, 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: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20251120153406
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: CHERISHED CARE HOME LLC
FACILITY NUMBER: 342701325
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2026
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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Licensee will ensure a staffing plan is developed which includes necessary availability to meet resident care and supervision needs. Plan to be submitted to LPA by POC due date.
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Based on interviews and record reviews, an instance occurred in which R1 did not receive the required 2:1 staffing ratio necessary for adequate care and supervision. This posed an immediate health and safety risk for 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: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/20/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20251120153406

FACILITY NAME:CHERISHED CARE HOME LLCFACILITY NUMBER:
342701325
ADMINISTRATOR:OMATSEYE, TOGHARANROSE ADAFACILITY TYPE:
735
ADDRESS:9268 CHAROLAIS WAYTELEPHONE:
(916) 868-2112
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 0DATE:
03/05/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ada OmatseyeTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident was dressed for the day
INVESTIGATION FINDINGS:
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On 3-5-2026 at 12:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegation noted above. LPA met with Administrator Ada Omatseye and explained the purpose of the visit. During the course of this investigation, LPA conducted interviews with Administrator, and reviewed facility file documentation including physician’s report and individual program plan (IPP) for resident1 (R1). Additionally, a facility observation was conducted by LPA Hayes on 11-25-2025.

Allegation: Staff did not ensure resident was dressed for the day. LPA conducted interviews, record reviews, and observation as noted above. This allegation is in regard to an observation conducted by an outside party which alleged that on or about 1120/2025, R1 was observed in his room in his pajamas with the door shut. Based on interviews conducted and records reviewed, it was revealed that R1 has a history of choosing not to get dressed for the day and instead wear pajamas. {Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20251120153406
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: CHERISHED CARE HOME LLC
FACILITY NUMBER: 342701325
VISIT DATE: 03/05/2026
NARRATIVE
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A review of R1’s IPP revealed that R1 may choose to wear clothes not suitable to various season of the year, but not specific to a choice to wear pajamas during specific times of the day. Based on the above investigation and given R1’s established right to wear clothes of his choosing, it is undetermined if staff did not ensure or attempted to ensure resident was dressed for the day. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator, and a copy of this report was provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5