347001947-6-5-2026-59-AS-LMUZ-DVHNPH-20260629103823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347001947
Report Date: 06/05/2026
Date Signed: 06/05/2026 02:11:19 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
05/19/2026 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260519113825

FACILITY NAME:	EVA'S CARE HOME		FACILITY NUMBER:	347001947
ADMINISTRATOR:	NEMETHY, EVA		FACILITY TYPE:	740
ADDRESS:	8220 CATALPA DRIVE		TELEPHONE:	(916) 727-1904
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 5	DATE:	06/05/2026
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Eva Nemethy, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff are obstructing fire exits to prevent residents from leaving.
Facility staff are leaving residents alone at the care home without supervision.
Facility is not providing adequate food services to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver investigative findings to a complaint received on May 19, 2026, and with met with Robert Kovacs, caregiver. LPA explained purpose of inspection. The administrator arrived at 12;35 pm.

During the investigation, LPA interviewed the administrator, (1) staff and (3) current residents. LPA attempted to interview a family member of resident (R1), who is the subject of the investigation, but was not able to contact them. LPA reviewed documentation including (R1's) Physician Report, Pre-Appraisal, Admission Agreement, and other documenation. LPA took photographs of the hallway near (R1's) room and the food on hand at the facility. The results of the investigation are as follows:

Resident (R1) moved to the facility on April 9, 2026, under a "respite" admittance for (2) weeks initially, but stayed until May 18, 2026. The physician reports notes (R1) has a diagnosis of Intertrochanteric fracture of right femur, history of falling, difficulty in walking, cognitive communication deficit and required asssitance with repositioning and transferring. (R1) also required a fortified diet, regular texture, thin consistency. *cont on 9099C-1..

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

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 7

Control Number 59-AS-20260519113825

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: EVA'S CARE HOME	FACILITY NUMBER: 347001947
	VISIT DATE: 06/05/2026

NARRATIVE

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9099C-1...The physician's report notes (R1) also needed assistance with bathing, dressing and toileting and can leave the facility with assistance. The Pre-Appraisal notes (R1) needed help with moving around the facility, toileting and needed special observation/night supervision due to confusion/forgetfulness.

Allegation: Facility staff are obstructing fire exits to prevent residents from leaving. The allegation states staff are putting chairs under the door handles at night to prevent residents from leaving the facility.

The Administrator and caregiver stated that a chair was placed outside of (R1's) room, with (R1's) permission to serve as a reminder for (R1) to call for assistance, when needed, to use the bathroom, or leave their room since it was near a ramp. Both staff stated this idea was approved by (R1's) Physical Therapist, due to (R1) having "mild Dementia- mostly memory issues". LPA viewed (R1's) room and chair that is kept outside the room in the hallway and took photos. LPA observed the top of the chair to be several inches below the door handle on (R1's) room and not be able to prevent the door from being opened. The chair was placed in front of the door, without touching it.

Both staff denied that any other chairs were placed in front of any other doors. LPA did not observe any chairs nearby other doors in the facility. Both staff confirmed that the facility has "on-call" staff who will provide regular incontinent care and answer when residents need assistance.(R1) was unable to be interviewed due to moving from the facility on/around May 18, 2026. LPA was also not able to contact a family member of (R1) after attempting to.

Based on interviews conducted and observations made, the allegation is 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.

Allegation: Facility staff are leaving residents alone at the care home without supervision. The allegation states it was understood that the care home had 24/7 supervision from caregivers; however, the care home does not have care staff at night.

The lead care staff confirmed the Administrator and another staff, who lives at the care home, were filling in when he went on vacation for two weeks. The Administrator stated she was working daily at the facility, including providing nighttime care and supervision, when the lead staff was out of the facility. The lead staff was adamant that staff is present at all times and staff has contacted 9-1-1, on multiple occasions, during the night time shift. *cont on 9099C-2..

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 59-AS-20260519113825

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: EVA'S CARE HOME	FACILITY NUMBER: 347001947
	VISIT DATE: 06/05/2026

NARRATIVE

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9099C-2.. The Lead staff stated he could hear the chair squeak when (R1) got up and slid the chair to the side, and one time it was at 2:00 am. This staff stated he caught (R1) a couple of times" at the bottom of the ramp without using her wheelchair", and (R1) did not request assistance before ambulating down the ramp in their wheelchair.

(R1) was unable to be interviewed due to moving from the facility on/around May 18, 2026. LPA was also not able to contact a family member of (R1) after attempting to.

Based on interviews conducted and observations made, the allegation is 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.

Allegation: Facility is not providing adequate food services to residents. The allegation states that (R1) is receiving a bologna sandwich for every meal and nothing else.

The lead staff stated bologna and other sandwiches are usually served at dinner, along with soups, salad and yogurt. and he offered (R1) bologna sandwiches and (R1) "never complained about it". Additionally, this staff offered (R1) eggs with spinach, but (R1) didn't like spinach or oatmeal, and confirmed (R1) was able to communicate. This staff added that (R1) would not eat any "green vegetables", even if blended in a smoothie.

The Administrator stated she purchases a variety of foods on a regular basis and shops at various grocery stores. Additionally, while the lead staff was away, she and a second staff picked up soups and sandwiches from Panera Bakery.

LPA observed the refrigerator and freezer to be full with fresh and frozen food on May 20, 2026, including meats and produce. LPA observed a fully stocked pantry also.

The administrator commented that (R1's) family "took them out a lot- they just took them early in the morning at 7:00" without telling the facility staff, and they would eat out a lot.

*cont on 9099C-3...

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 59-AS-20260519113825

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: EVA'S CARE HOME	FACILITY NUMBER: 347001947
	VISIT DATE: 06/05/2026

NARRATIVE

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9099C-3.. Three (3) residents stated to LPA that the facility serves a variety of food, and bologna sandwiches are not served at every meal. All residents stated the food is "good" with one resident asserting, "sometimes it is exceptional" and the food was "still good" when the main staff was on vacation.

(R1) was unable to be interviewed due to moving from the facility on/around May 18, 2026. LPA was also not able to contact a family member of (R1) after attempting to.

Based on interviews conducted and observations made, the allegation is 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. Copy of report provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

Page: 7 of 7

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
05/19/2026 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260519113825

FACILITY NAME:	EVA'S CARE HOME		FACILITY NUMBER:	347001947
ADMINISTRATOR:	NEMETHY, EVA		FACILITY TYPE:	740
ADDRESS:	8220 CATALPA DRIVE		TELEPHONE:	(916) 727-1904
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	6	CENSUS: 5	DATE:	06/05/2026
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Eva Nemethy, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility is not addressing resident's falls.

INVESTIGATION FINDINGS:

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During the investigation, LPA interviewed the administrator and (1) staff. LPA attempted to interview a family member of resident (R1), who is the subject of the investigation, and (R1) but was not able to contact them. LPA also reviewed documentation including (R1's) Physician Report, Pre-Appraisal, Admission Agreement, and other documenation. LPA took photographs of the hallway near where (R1) previously resided. The results of the investigation are as follows:

Resident (R1) moved to the facility on April 9, 2026, under a "respite" admittance for (2) weeks initially, but stayed until May 18, 2026. The physician reports notes (R1) has a diagnosis of Intertrochanteric fracture of right femur, history of falling, difficulty in walking, cognitive communication deficit and required asssitance with repositioning and transferring.

*cont on 9099A-C1..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

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 7

Control Number 59-AS-20260519113825

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: EVA'S CARE HOME	FACILITY NUMBER: 347001947
	VISIT DATE: 06/05/2026

NARRATIVE

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9099A-C-1... Allegation: Facility is not addressing resident's falls. The allegation states (R1) has several bruises due to falling and has sustained four (4) falls since residing at the care home. The complaint report does not reference the dates of the alleged (4) falls.

The lead staff stated (R1) fell before moving in and broke their hip and stated (R1) "was at risk for falling and would come out of their room, without a walker, even at 2:00 am, more than once". This staff stated, "the Physical Therapist told (R1) not to walk without a walker", confirmed (R1) would use a wheelchair sometimes, and he told (R1), "it's dangerous" if they don't use the wheelchair all the time.

The lead staff stated (R1) liked to use the guest bathroom near their room, but they needed to use the bathroom near the kitchen and explained, "If (R1) fell inside the guest bathroom, there is no way to open the door if they were blocking the door", confirming he and the administrator encouraged (R1) to use the larger bathroom with (2) doors, one on each end of the bathroom. This staff and the administrator stated (R1) never fell in the bathroom, but only slipped two times, from the wheelchair to the floor. When staff went to provide assistance, (R1) stated they "slipped", without any visible injuries or pain, and refused to be sent out. This staff provided (R1) with two pairs of hospital, non-skid socks and inspected (R1s) footwear.

The lead staff stated the administrator "was upset that he caught (R1) a couple of times" at the bottom of the ramp without using their wheelchair. This staff stated the administrator told (R1) and their family she can't keep (R1) because they are "not listening". The lead staff stated the family asked for a second chance, and it was agreed to extend their respite stay.

The Administrator stated she asked (R1) to call for assistance before going down the ramp in their wheelchair, but (R1) would forget and say they "promise not to again". The lead staff commented (R1) would use their wheelchair, hold the rail, and was good about calling for help during the day, but wasn't good about calling during the night. LPA took photos of the hallway area outside of the room where (R1) resided. LPA observed the hallway to have an incline when going to (R1's) room and a decline when leaving (R1's) room towards the common area. LPA observed hand rails on both sides.

Both the Administrator and lead staff stated that (R1) was regularly out of the facility and would spend days, at a time, with their family. Both staff confirmed that (R1) would refuse showers at the facility as they take them with their family member, which the family member confirmed with staff. *cont on 9099A-C2..

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 59-AS-20260519113825

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: EVA'S CARE HOME	FACILITY NUMBER: 347001947
	VISIT DATE: 06/05/2026

NARRATIVE

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9099A-C-2... Additionally, the administrator and staff stated that (R1) went out with some friends who picked (R1) up in a large SUV vehicle, high off the ground, at least twice. The visitor sign-in log shows one of these visits occurred on May 8, 2026. Both staff stated (R1) returned one time with a small Band-Aid on one of their upper arms. Staff provided First Aid and (R1) didn't provide any details.

Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview. Copy of report provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2026

LIC9099 (FAS) - (06/04)

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