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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347001881
Report Date: 09/01/2026
Date Signed: 09/02/2026 10:14:23 PM

Substantiated


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
05/28/2026 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20260528083456
FACILITY NAME:EDISON ESTATESFACILITY NUMBER:
347001881
ADMINISTRATOR:APUYA, MARY JANEFACILITY TYPE:
740
ADDRESS:3741 EDISON AVENUETELEPHONE:
(916) 484-7934
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 2DATE:
09/01/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Caregiver Romeo Apuya JrTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not ensure resident was taken back to the doctors for follow up visit
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Caregiver Romeo Apuya Jr and explained the reason for the visit. Census: 2
Staff did not ensure resident was taken back to the doctors for follow up visit- LPA Lund interviewed Staff, and witness. Based on interviews with Staff and Witness Resident (R1) missed a doctor’s appointment due the driver not being able to make the appointment. Facility Staff stated that they failed to make another appointment for R1.
Based on interviews with Staff and Witness, on the information provided, it clear that staff did not ensure resident was taken back to the doctors for follow up visit, therefore the allegation was deemed SUBSTANTIATED.

Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
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 5
Control Number 27-AS-20260528083456
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: EDISON ESTATES
FACILITY NUMBER: 347001881
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2026
Section Cited
CCR
87464(f)(6)
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(f) Basic services shall at a minimum include: (6) Arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services.
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Administrator will look over the regulation and email an uderstanding of the regulation to LPA Lund.
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This requirement is not met by: The facility staff adminted that they did make an appoitment for R1. This poses a potential risk to the safety and personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20260528083456
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: EDISON ESTATES
FACILITY NUMBER: 347001881
VISIT DATE: 09/01/2026
NARRATIVE
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As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. Per the California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed or cited and noted on LIC 809D
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/28/2026 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20260528083456

FACILITY NAME:EDISON ESTATESFACILITY NUMBER:
347001881
ADMINISTRATOR:APUYA, MARY JANEFACILITY TYPE:
740
ADDRESS:3741 EDISON AVENUETELEPHONE:
(916) 484-7934
CITY:SACRAMENTOSTATE:CAZIP CODE:
95821
CAPACITY:6CENSUS: 2DATE:
09/01/2026
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Caregiver Romeo Apuya JrTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are not meeting resident's bathing needs
INVESTIGATION FINDINGS:
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Staff are not meeting resident's bathing needs- LPA Lund observed Resident at the facility, interviewed staff and witnesses. Based reviewed facility paperwork, observation of residents and interviews with Staff and witnesses. LPA Lund reviewed Resident (R1) service plan dated 6/04/2026 R1 gets bathing assistance 3 days a week or as necessary. LPA Lund observed residents bathing needs are being meet during visits. Witness stated during visits never smelt are had any issues with residents bathing needs.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20260528083456
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: EDISON ESTATES
FACILITY NUMBER: 347001881
VISIT DATE: 09/01/2026
NARRATIVE
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Based on facility paperwork, observation, interviews with staff and witnesses on the information provided, it was unclear if staff are not meeting resident's bathing needs, the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegations may have happened or is valid, there is not preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted, and copies of the report and appeal rights left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5