347000731-4-23-2025-27-AS-CACL-DG9RRL-20250501131516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000731
Report Date: 04/23/2025
Date Signed: 04/23/2025 03:48:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
12/30/2024 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20241230143521

FACILITY NAME:	DOSTY'S PRIVATE IN CARE SERVICE III		FACILITY NUMBER:	347000731
ADMINISTRATOR:	CAROLYN J. DOSTY		FACILITY TYPE:	735
ADDRESS:	2041 50TH AVENUE		TELEPHONE:	(916) 399-0408
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95822
CAPACITY:	6	CENSUS:	DATE:	04/23/2025
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:			TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Neglect/Lack of supervision:
1) Facility staff abandoned resident.
2) Facility staff did not seek timely medical attention for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Dosty's Private Incare Service III ARF on 4/23/25 at 3:30pm to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. LPA conducted interviews with RP, R1, S1, A1 and attempted interview with SC (See confidential names list, LIC 811 dated 4/23/25). R1 and S1 denied being abandoned by the facility and the facility not seeking timely medical care. R1 reported not feeling well on the evening of Christmas eve and was taken to urgent care the following day. S1 denied abandoning R1 at urgent care and provided statements of taking another client to another medical appointment. R1 did require to be transferred to hospital as R1's vitals could not be stabilized while at urgent care. R1's IPP and physician reports indicate R1 can access the community independently and advocate for own medical care. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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 27-AS-20241230143521

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DOSTY'S PRIVATE IN CARE SERVICE III	FACILITY NUMBER: 347000731
	VISIT DATE: 04/23/2025

NARRATIVE

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Additionally, the facility has not abandoned R1 as evidenced by his continued care and living at this facility since initial placement. Facility continues to seek timely medical attention for R1 and has continued to transport and advocate for R1 while at medical appointments. LPA contacted family of R1 who denied any concerns for R1's care at the facility. LPA attempted to contact SC with no success.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Neglect/lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

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