345002909-4-3-2026-59-AS-LMUZ-DT7UCG-20260416152754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 04/03/2026
Date Signed: 04/03/2026 03:57:57 PM

Substantiated

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
02/23/2026 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20260223135839

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: 41	DATE:	04/03/2026
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Liz Cruz, Executive Director		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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-Staff do not ensure medications are dispensed as prescribed

INVESTIGATION FINDINGS:

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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 a visit conducted on February 25, 2026, LPA conducted a medication count for residents (R2, R3, R4, & R5), comparing the residents' medication lists on file with medication centrally stored for the residents. LPA observed three (3) medications for R2 that were over the amount documented. R3 had two (2) medications that were over the amount documented. R4 had four (4) medications that were over the amount documented. R5 had two (2) medications that were over the amount documented.
Based on a medication count and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.
Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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 59-AS-20260223135839

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/03/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/06/2026 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility agrees to provide an in-service training to all med techs regarding job duties to address medication management and submit to LPA by the POC due date of 4/6/26. Facility will also complete bi-weekly audits of all medications for the next two months and submit them to LPA.
	8 9 10 11 12 13 14	Based on medication count and records reviewed, the facility did not ensure that residents (R2, R3, R4, & R5) were receiving medications as prescribed, which poses an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14	Facility requested an extension to complete training by 4/8/26.
	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: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC9099 (FAS) - (06/04)

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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
02/23/2026 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20260223135839

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: 41	DATE:	04/03/2026
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Liz Cruz, Executive Director		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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-Staff speaks inappropriately to residents
-Staff member worked while under the influence of alcohol impairing their ability to provide adequate care and supervision
-Staff falsify residents records

INVESTIGATION FINDINGS:

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

On February 25, 2026, LPA and the Local Long-Term Care Ombudsman (LTCO) conducted a joint visit at the care home. During the course of the investigation, LPA and LTCO conducted interviews. Interview with resident (R1) indicated that facility staff treat them well. R1 indicated that staff do not yell at residents. Interviews with staff (S1, S2, S3, S4, and S5) indicated that they have never witnessed staff speaking inappropriately to residents in care. Interviews with S1, S2, S3, S4, and S5 indicated that they have never witnessed a staff member working while under the influence of alcohol. Interview with the ED indicated

*******************************************Continued on LIC9099-C******************************************************

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 59-AS-20260223135839

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: 04/03/2026

NARRATIVE

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that they have never had any complaints regarding a staff member working under the influence of alcohol. Interviews with S1 and S2 indicated that they have never witnessed staff falsifying documentation regarding medications. S1 indicated that there is a certain way to document medication refusals and explain why. S2 indicated that there are not many medications that are provided during the NOC shift and they ensure all documentation is accurate. S3, S4, and S5 do not handle medication documentation.

Based on interviews conducted, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are 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: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC9099 (FAS) - (06/04)

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