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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700173
Report Date: 03/04/2026
Date Signed: 03/04/2026 10:52:20 AM

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
10/24/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251024090134
FACILITY NAME:PEOPLE'S CARE WILLORAFACILITY NUMBER:
392700173
ADMINISTRATOR:FACILITY TYPE:
735
ADDRESS:949 WILLORA RDTELEPHONE:
(209) 957-3662
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:5CENSUS: 4DATE:
03/04/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Wilkins N.TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff did not seek medical attention for serious injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Albert Johnson arrived at the facility to deliver findings for the above allegation.

Allegation: Neglect/Lack of Care & Supervision - Staff did not seek medical attention for serious injury.

On 10/20/2026, R1 was hospitalized after complaints of back pain.
X-Rays later revealed a horizontal fractured sacrum. Per staff Individual Service Plan (ISP) notes, R1 suffered three known falls leading up to hospitalization (10/13/2025, 10/15/2025, 10/18/2025).
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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 2
Control Number 27-AS-20251024090134
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: PEOPLE'S CARE WILLORA
FACILITY NUMBER: 392700173
VISIT DATE: 03/04/2026
NARRATIVE
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Staff who were interviewed did not recall R1 complaining of pain after the falls. Other residents did not witness R1 fall or witness R1 complaining of pain. R1 did not recall the details surrounding the injury but expressed wishes to return to the care home.

Facility notes corroborate that R1 did not complain of back/hip pain until 10/19/2025, when she was unable to get out of bed. There is no information to suggest that R1 remained in pain after her initial complaint in the morning. Staff conducted thorough body checks and completed detailed shift notes, all of which corroborate a lack of complaints prior to R1's hospitalization.

Additionally, notes indicate that staff transported R1 to her scheduled appointment on 10/17 /2025 for R1's pre-existing foot injury.

There is insufficient evidence to suggest that R1 suffered pain which may have warranted emergency medical attention prior to 10/20/2025.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2