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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920127
Report Date: 03/13/2026
Date Signed: 03/13/2026 04:08:24 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
02/04/2026 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20260204094924
FACILITY NAME:REGENCY RETIREMENT LLCFACILITY NUMBER:
345920127
ADMINISTRATOR:RAI, BALWINDERFACILITY TYPE:
740
ADDRESS:5600 ERSKIN FISH WAYTELEPHONE:
(916) 945-2122
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:6CENSUS: 5DATE:
03/13/2026
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Balwinder RaiTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff did not seek timely medical care for resident
INVESTIGATION FINDINGS:
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On March 13, 2026, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility and delivered the finding for the allegation cited above. LPA met with Administrator and explained the purpose of the visit.

During the course of investigation, LPA conducted extensive file reviews and interviews. For the allegation, Staff did not seek timely medical care for resident, interview with Administrator revealed that it is facility's protocol to contact emergency medical services if a resident has a fall, reports chest pains and/or not on baseline. During day of incident, resident (R1) had an appointment which then at the appointment, R1 was sent out for medical attention as R1 looked off baseline. File review of R1's charting notes did not have any documentation regarding R1 complaining of chest pains. LPA was unable to speak to R1 as R1 sustained a stroke and was nonverbal during LPA's visit. R1 has since been relocated to skilled nursing for rehabilation. File review of R1's LIC 602 revealed R1 is often disoriented and confused of time and year.

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

DATE: 03/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2026
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-20260204094924
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: REGENCY RETIREMENT LLC
FACILITY NUMBER: 345920127
VISIT DATE: 03/13/2026
NARRATIVE
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LIC 9099-C

Interview conducted with Assistant Administrator revealed she was working at the facility when R1 left the facility for a medical appointment. There was no report of chest pain, nausea and/or vomiting. R1 was observed to be on baseline, as R1 was informing staff when R1 needed to be changed and reminding staff of R1's medical appointment. Based on information obtained, the allegation is unsubstantiated.

As a result of this investigation, LPA finds allegation to be (US) Unsubstantiated - A finding that the complaint 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 with administrator and report copy provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2