345002909-3-19-2026-59-AS-LMUZ-DSGU7Q-20260324152020

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 03/19/2026
Date Signed: 03/19/2026 04:26:31 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
11/24/2025 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20251124123646

FACILITY NAME:	COGIR OF FOLSOM		FACILITY NUMBER:	345002909
ADMINISTRATOR:	CRUZ, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	1801 EAST NATOMA STREET		TELEPHONE:	(916) 608-0800
CITY:	FOLSOM	STATE: CA	ZIP CODE:	95630
CAPACITY:	66	CENSUS: 42	DATE:	03/19/2026
		UNANNOUNCED	TIME BEGAN:	02:55 PM
MET WITH:	Liz Cruz, Executive Director		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Due to lack of supervision, resident had a physical altercation with another resident resulting in resident falling

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Executive Director, Liz Cruz, to deliver complaint investigation findings regarding the above stated allegation.

During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation.

Interviews with staff present at the time of the incident involving residents (R1 and R2) on November 16, 2025, indicated that the only witness to the incident was staff (S2). Interview with S2 indicated that, as they were assisting another resident in the common area, they witnessed an incident between R1 and R2. S2 stated that R1 and R2 had their hands linked together and, when R1 and R2 let go of each other’s hands, R1 lost their balance and fell. Facility had R1 sent to the hospital for evaluation. Incident Report provided by the facility indicated the same information as the witness’s statement. Interviews with staff
**********************************************Continued on LIC9099-C**************************************************

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

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-20251124123646

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: 03/19/2026

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

indicated that the other caregivers on duty at the time of the incident were assisting other residents and the med tech was in the medication room. Interviews with staff indicated that they were not short staffed and there was no lack in care or supervision at the facility. According to the staff schedule, the facility was fully staffed on the date of the incident. R1’s After Visit Summary and Progress Notes indicated that R1 returned to the facility from the hospital on November 19, 2025. There were no injuries reported and R1 had a change in their medication.

According to R2’s Behavioral Expression Monitoring Log, R2 had incidents of aggressive behaviors towards other residents on October 27, 2025, October 28, 2025, and October 31, 2025 without injuries. The facility responded to the incidents by conducting a care conference with R2’s responsible party and reassessing them with the update in behaviors, which was signed on October 30, 2025. Between October 30, 2025 and November 12, 2025, the facility was in communication with R2’s physician and their responsible party to ensure they address R2’s changes in behaviors. The facility provided documentation indicating that R2’s physician had made adjustments to medications for behaviors as well as included antibiotics for Urinary Tract Infection (UTI). One medication utilized to reduce behaviors was increased on November 12, 2025 as well as another Urinalysis ordered for monitoring of UTI. Due to the November 16, 2025 incident, the facility immediately implemented one on one care to provide additional care and supervision for R2. The facility provided invoices indicating the dates of service from November 17, 2025-November 23, 2025.

Based on interviews conducted and documentation obtained, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. No deficiencies are being cited.

Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2