345002823-7-2-2026-59-AS-LCRR-DW2NTX-20260716104526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002823
Report Date: 07/01/2026
Date Signed: 07/02/2026 05:34:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
01/21/2026 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20260121084853

FACILITY NAME:	WHOLESOME ELDERLY ON KIFISIA		FACILITY NUMBER:	345002823
ADMINISTRATOR:	FAAMAUSILI,CHRIS		FACILITY TYPE:	740
ADDRESS:	6024 KIFISIA WAY		TELEPHONE:	(916) 678-0268
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 6	DATE:	07/01/2026
		UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Kristina Johnson, Caregiver		TIME COMPLETED:	05:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff leaves resident in soiled clothing/linens for an extended period of time

Facility staff are violating residents' personal rights

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Michael Hood arrived at the care home and met with caregiver, Kristina Johnson, to deliver findings regarding the complaint allegations listed above. LPA spoke with Administrator, Shaine Swogger, via telephone call, who gave permission for caregiver to sign the report. During investigation, LPA conducted interviews, toured the premises, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Allegation: Staff leaves resident in soiled clothing/linens for an extended period of time

Interview with resident (R1) indicated that they had an incident in which their catheter leaked on their bed and floor and staff did not provide assistance with cleaning. LPA reviewed Charting Notes and Incident Reports for R1 and identified incident in which R1 reported to LPA. LPA did not observe any information from Charting Notes or Incident Reports indicating R1’s catheter leaked on their furniture.
** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

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 2

Control Number 59-AS-20260121084853

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WHOLESOME ELDERLY ON KIFISIA	FACILITY NUMBER: 345002823
	VISIT DATE: 07/01/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed R1’s Medical Assessment dated December 16, 2025 which indicates that R1 has a colostomy and suprapubic catheter. R1’s Medical Assessment states that R1 is able to care for their own toileting needs.

Interviews conducted with residents (R2, R3, R4, R5, and R6) indicated that they felt their care needs are being met and they don’t have concerns regarding care staff. Interviews with residents indicated that they have never witnessed another resident in need of incontinence care and not receiving it. Interviews with staff members (S1, S2, and S3) indicated that they have never witnessed a resident in need of incontinence care and not receiving it. During visits conducted on January 23, 2026, June 18, 2026, and July 1, 2026, LPA did not observe any residents in need of incontinence care and not receiving it. During visits, LPA observed care home to be clean and free from odors.

Allegation: Facility staff are violating residents' personal rights

Interviews conducted with R2, R3, R4, R5, and R6 indicated that they have no concerns regarding staff. Interviews with residents indicated that they have not experienced their personal rights being violated and have never witnessed another resident’s rights to be violated. Interviews conducted with S1, S2, and S3 indicated that they have never violated a resident’s personal rights nor have witnessed another staff member violate a resident’s personal rights.

Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2