347000985-1-26-2026-27-AS-SRIN-DR23M8-20260205172154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347000985
Report Date: 01/26/2026
Date Signed: 01/26/2026 04:28:59 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
09/24/2025 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250924153705

FACILITY NAME:	GOLDEN POND RETIREMENT COMMUNITY		FACILITY NUMBER:	347000985
ADMINISTRATOR:	RYAN NAKAO		FACILITY TYPE:	740
ADDRESS:	3415 MAYHEW ROAD		TELEPHONE:	(916) 369-8967
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95827
CAPACITY:	175	CENSUS: 86	DATE:	01/26/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Ryan Nakao		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not administer medication to a resident in care.
Staff did not ensure that residents medications were ordered in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA Valerio met with Administrator Ryan Nakao, and explained the purpose of the visit.

It was alleged that resident's medications were not ordered in a timely manner and that the staff did not give a resident medication for two days. According to the reporting party, the RP states that it is the seventh (7th) time the facility has failed to order medications in time. The RP has brought this concern up with the Executive Director; however, it continues to occur.

The following has been determined as it relates to the aforementioned allegations.

LPA Valerio reviewed facility records for four (4) resident. Facility records included the Electronic Medication Administration Record (EMAR), Progress Notes, and Fax Communication with Doctors.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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 27-AS-20250924153705

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: GOLDEN POND RETIREMENT COMMUNITY	FACILITY NUMBER: 347000985
	VISIT DATE: 01/26/2026

NARRATIVE

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Resident 1 (R1) had a paper MAR and an EMAR for review. On the EMAR, there were medications that had missing signatures on September 5, 8,13,20, 26; however, there were medication technician notes that showed that the medications were given and the charting was done late.

For Resident 2 (R2), R2 had all medications signed off for except for two blood sugar readings. there were no notes on the end pages to indicate why the sugar readings were not done; however, medications related to diabetes, such as insulin and glipizide were given on those dates and times. LPA Valerio reviewed correspondence between the facility and the doctor's office. LPA only saw correspondence regarding insulin and glucose readings. According to a progress note written by staff, R2 had an expired glucose sensor on their arm that was not replaced by staff. According to the staff, the administrator corrected the issue.

For Resident 3 (R3), R3 had zero missed medications for this time frame; all medications were signed off by staff members for the month of August and September. LPA Valerio reviewed correspondence between the facility and the doctor's office. LPA was provided three pages. One note showed a new order that was dated by the doctor on August 14, 2025. A sticky note written by staff, Noted & Charted & Updated Sunday 08/24/2025…" LPA Valerio reviewed a progress note written by staff, which stated that staff admitted to giving an inhaler to R3 and it was nearly empty, and there was not another one in back up for use. Staff reported to order it that same day and the Administrator went to go pick up the medication.

For Resident 4 (R4), R4 had all medications signed off for. R4 had a few entries that were questionable as to whether the facility had the medications or not. For example, ferrous Sulfate Oral Tablet is to be given 1 tablet by mouth twice per day. On September 20, 2025 at 5:00 PM, staff stated the "Drug was not available". On September 21, 2025 at 8:00 AM, staff stated the "Drug was not available", however, at 8:00 PM on September 21, 2025, staff signed off stating that the medication was given. On September 22, 2025 at 8:00 AM, staff stated the "Drug was not available", however, at 8:00 PM on September 22, 2025, staff signed off stating that the medication was given.

According to facility staff, the facility implemented a policy in September of 2025: Two med techs are assigned per medication cart to do daily inventory of each cart and any/all medication MUST be refilled when there is only 12 days remaining.

Based on all the information collected by the Department, although the allegation may have happened or is valid, here is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

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