<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 10/14/2025
Date Signed: 10/14/2025 01:12:31 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
03/05/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20250305101720
FACILITY NAME:COGIR OF FOLSOMFACILITY NUMBER:
345002909
ADMINISTRATOR:TAYLOR, DEBORAHFACILITY TYPE:
740
ADDRESS:1801 EAST NATOMA STREETTELEPHONE:
(916) 608-0800
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:66CENSUS: 42DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Elizabeth CruzTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not ensure that resident's showering needs are being met.
Facility staff did not intervene in verbal altercation between residents.
Facility staff spoke inappropriate to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 14, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the findings of the allegations cited above.

LPA met with interim Executive Director and explained the purpose of the visit.

During the course of this investigation, LPA conducted extensive interviews.

The result of the allegation is as follow on LIC9099-C(1).

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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
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
03/05/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20250305101720

FACILITY NAME:COGIR OF FOLSOMFACILITY NUMBER:
345002909
ADMINISTRATOR:TAYLOR, DEBORAHFACILITY TYPE:
740
ADDRESS:1801 EAST NATOMA STREETTELEPHONE:
(916) 608-0800
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:66CENSUS: 42DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Elizabeth CruzTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not provide a refund.
Facility staff did not provide resident medications at prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 14, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the findings of the allegations cited above. LPA met with interim Executive Director and explained the purpose of the visit.

For the allegation of, Facility staff did not provide a refund, the Department conducted interviews and file reviews. Based on interview conducted with Executive Director on March 7, 2025, it revealed that a refund was issued to resident (R1)’s responsible party. File review of R1’s detail ledger revealed that the remaining balance was transferred over on February 26, 2025, which a check total of $2,075 was issued to R1’s responsible party on March 6, 2025. Therefore, the allegation is unfounded.

Please continue on LIC 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 59-AS-20250305101720
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: COGIR OF FOLSOM
FACILITY NUMBER: 345002909
VISIT DATE: 10/14/2025
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
LIC 9099-C

For the allegation of, Facility staff did not provide resident medications at prescribed, the Department conducted file reviews of R1’s medication list, narcotic count record, medication release record, and emergency paper medication administration record. Records revealed that on the medication list effective January 24, 2025, R1 was prescribed PRN Ativan 0.5mg one tablet by mouth twice a day as needed. Then effective February 3, 2025, PRN Ativan 0.5mg was changed to one tablet by mouth three times a day as needed. File review of narcotic count record revealed that after R1’s first dose given on February 1, 2025, there was a remaining of 87 tablets of Ativan 0.5mg and after the last dose given on February 10, 2025, there was a remaining of 68 tablets. From February 1, 2025 to February 2, 2025, R1 received maximum of one tablet per day as needed. From February 3, 2025 to February 10, 2025, R1 did not receive more than three tablets per day, compliance to R1’s physician order of the PRN Ativan. Medication release record revealed it was signed off by R1’s responsible party that Ativan 0.5mg was entrusted to R1’s responsible party with the total count of 68 tablets. Therefore, allegation is unfounded.

Based on the information obtained, the Department concluded that the allegations are unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted, and a copy of the report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 59-AS-20250305101720
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: COGIR OF FOLSOM
FACILITY NUMBER: 345002909
VISIT DATE: 10/14/2025
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
LIC 9099-C(1)

For the allegation, Facility staff did not ensure that resident's showering needs are being met, the Department conducted several interviews. Interview conducted with resident (R2) revealed that staff does assist R2 with showering. When asked if R2 is having any issues with staff not meeting R2's showering needs, R2 indicate R2 does not think there is any issues. R2 stated R2 cannot remember much but think they are getting all their showers. File review of R2's LIC 602 revealed that R2 has dementia. Interview conducted with resident (R3) revealed that R3 has recently moved in the facility but really likes the staff. R3 denied having any issues regarding showering needs, and expressed that R3 is satisfied at the facility. R3 receives showering twice a week. Interview conducted with resident (R4) revealed that R4 does not need much assistance from staff with showering but likes stand-by assist. R4 does not know if there are any concerns with showering needs. File review of R4'sLIC 602 revealed that R4 does have dementia. Interview conducted with R5 revealed that R5 receives assistance with showering. R5 does not believe there are any issues with staff not meeting resident's showering needs. Due to the lack of information the Department was able to obtain, the allegation is unsubstantiated.

The allegation of, Facility staff did not intervene in verbal altercation between residents, the Department conducted extensive interviews. Interview conducted with Health and Wellness Director revealed that when residents are having a verbal altercation, staff are to assist with de-escalating the situation. Staff are to isolate the aggressor to see if they want to do any activities. Interview conducted with Executive Director revealed that the facility is a memory care facility where residents are often having behaviors. If residents are engaged in an altercation, staff should intervene to ensure the health and safety of residents in care. The facility has several corners where if guests or visitors are observing an altercation, they are to report the incident to staff for staff to redirect. Executive Director reported that this alleged incident was not brought to their attention and there was not enough information to investigate further. There were no known witnesses to such an incident. Interview conducted with R2, R3, R4 and R5 reported they feel safe at the facility. Therefore the allegation is unsubstantiated.

Please continue on LIC9099-C (2).
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20250305101720
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: COGIR OF FOLSOM
FACILITY NUMBER: 345002909
VISIT DATE: 10/14/2025
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
LIC 9099-C(2).

For the allegation of, Facility staff spoke inappropriate to resident, the Department conducted interviews to investigate the following. Interview conducted with Health and Wellness Director revealed that R1 was new at the facility and was very dependent on R1's roommate for social interaction and activities but staff did not speak to R1 in any ill manner. Interview further revealed that staff are to assist and motivate R1 with integrating into the community and ensuring R1 feels comfortable with other residents in care. Interview conducted with R3 revealed that R3 has not witnessed staff speaking to residents inappropriately. Interview conducted with Executive Director revealed that the alleged incident was brought to her attention by a family member but there was no information on what day this occurred, no information on which staff member allegedly spoke inappropriately to R1 and/or other residents. Due to lack of information available for the Department to investigate, the allegation is unsubstantiated.

As a result of this investigation, it was determined the allegations are to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.

Exit interview and a copy of the report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5