342701363-2-5-2026-27-AS-SRIN-DS9QXX-20260317123416

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701363
Report Date: 02/05/2026
Date Signed: 02/05/2026 12:08:23 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
10/01/2025 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20251001102433

FACILITY NAME:	IVY PARK AT SACRAMENTO		FACILITY NUMBER:	342701363
ADMINISTRATOR:	WEININGER, SARA		FACILITY TYPE:	740
ADDRESS:	345 MUNROE STREET		TELEPHONE:	(916) 486-0200
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	70	CENSUS: 59	DATE:	02/05/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sara Weininger		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Resident was sexually assaulted by staff while in care.

INVESTIGATION FINDINGS:

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On 2/5/2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannouced at this facility to conduct a follow-up complaint investigation and deliver findings regarding the allegations noted above.

LPA met with the Executive Director/Administrator, Sara Weininger (AD) and stated the purpose of this visit.

R1 disclosed to a hospice home health aide during a bed bath on 9/26/2025 that R1 had been “rape.” This concern was reported to hospice and facility staff and then to licensing. Facility staff responded promptly by checking on R1, completing a body check, and initiating an internal investigation. No injuries or signs of physical harm were observed during the assessment.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

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-20251001102433

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: IVY PARK AT SACRAMENTO	FACILITY NUMBER: 342701363
	VISIT DATE: 02/05/2026

NARRATIVE

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The investigation included a review of facility reports, medical records, and interviews. Facility records showed that R1 received bed baths on 9/23/2025 and 9/26/2025 by hospice staff, which matched the timing of R1’s statements. However, no staff reported witnessing or hearing R1 make similar statements outside of these incidents. Records confirmed that R1 has a diagnosis of Alzheimer’s dementia, with periods of confusion, disorientation, sundowning behaviors, and depression. Family members reported that R1 had made similar allegations in the past at another placement, which reportedly stopped after medication was prescribed and later R1’s allegations resumed when those medications were discontinued for hospice care.

During a follow-up interview conducted on 10/23/2025 by the Department, R1 did not disclose any sexual assault. Due to the lack of physical evidence, the absence of witnesses, inconsistent disclosures, and R1’s documented cognitive impairment, there was insufficient evidence to confirm that a sexual assault occurred. The allegation that R1 was sexually assaulted by staff while in care could not be proven or disproven, and therefore the finding is UNSUBSTANTIATED.

Note that an unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies were cited during this visit. An exit interview was conducted with AD and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026

LIC9099 (FAS) - (06/04)

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