342701545-5-13-2026-27-AS-SRIN-DUQUQJ-20260604154713

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701545
Report Date: 05/13/2026
Date Signed: 05/13/2026 01:28:25 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 Christina Valerio

COMPLAINT CONTROL NUMBER: 27-AS-20260325111500

FACILITY NAME:	FARAI CARE CENTER		FACILITY NUMBER:	342701545
ADMINISTRATOR:	JACKSON, ANTONIO		FACILITY TYPE:	735
ADDRESS:	12415 WHEAT RIDGE DRIVE		TELEPHONE:	(661) 858-4069
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95742
CAPACITY:	4	CENSUS: 1	DATE:	05/13/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Janet Meda		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff speaks inappropriately to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with Facility Staff Janet Meda, and explained the purpose of the visit.

Allegation: Staff speaks inappropriately to residents
The investigation consisted of interviews with residents, interviews with staff, and a review of Declaration Statement submitted by Witness 1 (W1).

LPA Valerio and LPA Jamaly interviewed three (3) out of three (3) residents. According to R1, R1 had a supervised visit with R1's newborn baby. R1 overheard Staff 1 (S1) speaking to the visitor holding R1's baby. R1 reported S1 said the following: "“[S1] was talking with [W1] about [R1's] fist time ejaculation and how [R1] felt for the first time. [R1] also was talking about [R1] interest about specific types of women. [R1] continued talking with [W1] about inappropriate personal matters.” R1 further stated that R1 felt uncomfortable.
Continues on LIC 9099 - C...

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

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-20260325111500

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: FARAI CARE CENTER	FACILITY NUMBER: 342701545
	VISIT DATE: 05/13/2026

NARRATIVE

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R1 reported that S1 was very aggressive and impatient with the residents.

According to an interview with Resident 2 (R2), R2 stated there were plenty of times when they felt uncomfortable with S1. Examples provided by R2 were raising S1's voice and getting close to R2 in an intimidating manner. R2 said those behaviors stopped after R2 address it with other staff,

According to an interview with Resident 3 (R3), R3 stated there were no concerns.

According to a Declaration Statement provided by W1, S1 stated the following in front of residents and with R1's baby: [S1] continued to ask if I was single, and if I preferred older men. [S1] continued to express without prompt or being asked to elaborate on [S1's] life, that [S1] always been attracted to older women and how older women have always been attracted to [S1]. [S1] then disclosed, again without prompt, the following, "When I was 19, my mom used to always have her friends come over and her friends were my mom's age or older. One of her friends was really interested in me and next thing I know, we're in the bedroom and I look down and saw that I ejaculated all over myself....." ...This happened on Thursday March 5th, 2026."

LPA Valerio interviewed S1. S1 stated S1 would speak to them directly, I would be honest. S1 denied the allegation of speaking inappropriately. S1 stated S1 said everything else exception the ejaculation. S1 reported that S1 told them about my mother's friend but not the ejaculation part.

According to interviews with Staff (S2) and Staff 3 (S3), they did not witness the interaction that occurred on March 5, 2026. S2 stated S2 keeps to self and does their job. S3 stated this occurrence was the first time and S1 did not have any other incidents.

Per California Code of Regulations (CCR) - Title 22 - deficiencies are being cited on the attached LIC 9099 - D. Appeal Rights were provided. Failure to correct deficiencies may result in civil penalties.

An exit interview was held with facility staff Janet Meda, and a copy of this report was provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20260325111500

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: FARAI CARE CENTER	FACILITY NUMBER: 342701545
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/13/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/14/2026 Section Cited CCR 80072(a)(1)	1 2 3 4 5 6 7	80072 Personal Rights(a)...each client shall have personal rights which include, but are not limited to, the following:(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced:	1 2 3 4 5 6 7	Licensee stated they terminated S1 and have hired a new administrator. Licensee had all staff training regarding resident's personal rights. LPA Valerio observed staff to have training on 04/20/2026 for Client Personal Rights and Mandated Reporting.
	8 9 10 11 12 13 14	Based on records review of W1 Declaration Statement and interviews with residents, the licensee did not ensure S1 spoke to residents appropriately, which posed an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

LIC9099 (FAS) - (06/04)

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