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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002909
Report Date: 07/08/2026
Date Signed: 07/08/2026 04:20:17 PM

Unfounded


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
04/14/2026 and conducted by Evaluator Angela Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260414095727
FACILITY NAME:COGIR OF FOLSOMFACILITY NUMBER:
345002909
ADMINISTRATOR:CRUZ, ELIZABETHFACILITY TYPE:
740
ADDRESS:1801 EAST NATOMA STREETTELEPHONE:
(916) 608-0800
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:66CENSUS: 42DATE:
07/08/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Liz Cruz, Executive DirectorTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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-Resident sustained injuries due to staff neglect or physical abuse
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 the course of the investigation, LPA conducted interviews, obtained documentation, and made observations.


*********************************************Continued on LIC9099-C***************************************************
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
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-20260414095727
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: 07/08/2026
NARRATIVE
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On April 15, 2026, the facility provided CCLD an Unusual Incident/Injury Report indicating that, on April 13, 2026, resident (R1) was exhibiting verbally and physically aggressive behavioral expressions when staff (S2) was attempting to assist R1 with activities of daily living (ADLs). The Health and Wellness Nurse (HWN), Melanie Cornish, contacted emergency medical services and R1 was transported to the hospital. According to R1's progress notes and facility's internal incident report, the HWN was called to assist S2 as R1 was observed to be grabbing and swinging at S2 while they were attempting to assist with R1's incontinence care. Progress notes and incident report indicated that R1 continued to yell and swing at care staff in addition to kicking and trying to bite care staff. The HWN observed R1 to have a skin tear on their elbow and wrist from their medical emergency bracelet. The HWN called 911 and R1 was sent out via ambulance for further evaluation. According to the Emergency Department Patient Discharge documentation, R1 was admitted for displaying symptoms of neurocognitive decline. R1 was discharged from the hospital on April 14, 2026 with changes to their medications prescribed for agitation and insomnia. R1's diagnosis upon discharge was agitation due to dementia, and there were no notations of injuries sustained.

Interviews with staff present during the incident, including HWN, staff (S1), and S2, indicated that R1 was exhibiting aggressive behavioral expressions on the date of the incident. Staff indicated that R1 was receiving assistance with toileting at the time of the incident. HWN indicated that R1 was grabbing staff and hitting the wall next to the toilet. S1 indicated that R1 had their arm linked in the grab bar next to the toilet and would not let go. S2 indicated that R1 was swinging at them when they were assisting in the restroom. Staff indicated that R1 hit their arm on the wall while they were attempting to redirect. Staff indicated that they were able to redirect R1 to their bed where they continued the aggressive behavioral expressions. Staff indicated that emergency medical was contacted. HWN indicated that, upon R1's return to facility on April 14, 2026, there were some changes to R1's medication, which helped with their behavioral expressions.

Interview with R1 indicated that staff treat them well and they have not had any trouble with staff. R1 indicated that staff do not neglect or physically abuse them. R1 stated that they are physically okay but their mind wanders a lot. LPA observed the skin on R1's arms, which appeared thin and had reddish purple spots that are commonly caused during the skin's natural aging process.

Based on documentation obtained, interviews conducted, and observations, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or are without a reasonable basis. 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: 07/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026
LIC9099 (FAS) - (06/04)
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