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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920204
Report Date: 06/11/2025
Date Signed: 06/11/2025 03:24:11 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
03/19/2025 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20250319140717
FACILITY NAME:REMINISCE CARE RETREAT 1FACILITY NUMBER:
345920204
ADMINISTRATOR:ROMERO, S RUSSELFACILITY TYPE:
740
ADDRESS:3425 PALESTINE LNTELEPHONE:
(916) 483-5507
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
06/11/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Russel Romero, AdministratorTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff did not provide adequate food service to resident in care

Staff made resident stay in their room

Staff did not ensure resident's hygiene care needs were met

Staff did not ensure resident's walker was in good repair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Russel Romero, to deliver findings into the complaint allegations listed above.

During the investigation, LPA conducted interviews, toured the premises, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Relevant party reported to the Department that staff did not provide adequate food service to resident in care, staff made resident stay in their room, staff did not ensure resident's hygiene care needs were met, and staff did not ensure resident's walker was in good repair.

** Report continued on 9099-C **
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
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 2
Control Number 59-AS-20250319140717
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: REMINISCE CARE RETREAT 1
FACILITY NUMBER: 345920204
VISIT DATE: 06/11/2025
NARRATIVE
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LPA conducted interviews with residents R1, R2, R3, R4, R5, and R6, as well as staff members S1, S2, and S3, and Administrators Russel Romero and Jeroboam Ninobla. None of the interviews conducted by LPA with the individuals listed above indicated any concerns regarding the allegations addressed in complaint. During visits conducted March 21, 2025, June 5, 2025, June 10, 2025, or June 11, 2025, LPA did not observe any residents with broken assistive devices, did not observe any residents prevented from leaving their room, did not observe food services to be inadequate, and did not observe residents in need of hygiene assistance and not receiving it by facility staff. LPA reviewed "Daily Report of Activities of Daily Living (ADL)" for R1 and observed R1 receiving regular care and supervision by facility staff.

Based on interviews conducted, LPA's observations, and records reviewed, the above allegations are found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2