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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700366
Report Date: 11/25/2025
Date Signed: 12/02/2025 10:02:42 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
07/31/2025 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250731150030
FACILITY NAME:COMMONS AT UNION RANCH, THEFACILITY NUMBER:
392700366
ADMINISTRATOR:SHERYL BRAVOFACILITY TYPE:
740
ADDRESS:2241 N UNION ROADTELEPHONE:
(209) 463-9100
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:135CENSUS: 103DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Marcy BorlandTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff are not meeting residents toileting needs
Facility staff leave residents soiled for an extended period of time
Facility staff are not meeting residents nutritional needs
Facility staff did not provide adequate supervision to a resident who is a fall risk
Facility staff are not meeting residents bathing needs
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 11/25/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility representative, Marcy Borland, who was briefly interviewed at this time. This LPA requested that she go ahead and contact the facility designated Administrator, Sheryl Bravo, to inform her that CCL was present at this time.
This LPA was informed that the facility designated Administrator was not able to come to this facility at this time due to health concerns. This visit was conducted with the Business Officer Manager, Marcy Borland, at this time. Current census was 103 residents.
The purpose of this visit was to inform this facility, and its representatives, about the findings of this investigation in relation to the above allegations.
Based on interviews conducted during this investigation, it was learned that this facility used to employ the services of a third party agency who provided temporary staff to serve as caregivers to this facility. This practice was utilized until the end of September 2025 when this facility finally decided to end the contract and no longer accepted any temporary caregivers from this agency.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
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-20250731150030
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: COMMONS AT UNION RANCH, THE
FACILITY NUMBER: 392700366
VISIT DATE: 11/25/2025
NARRATIVE
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It was learned that this facility employed staff to cover 24 hours of care and supervision and broke the hours into three 8 hour shifts. These shifts were the AM, PM, and NOC shift. It was learned that in the Memory Care Unit there were 3 caregivers present at each shift with one dedicated Medication Technician as well.
It was learned that the staff coverage was related to the overall resident census and would fluctuate if the census went down or go up if additional residents were admitted for care.
Based on a review of the forms and documents provided, specifically the LIC 500, it was observed that the number of staff present for each shift did reflect the outlined numbers of 3 caregivers with one Medication Technician at this time.
A tour of the memory care unit was conducted and it was observed that furniture, furnishings, and most items intended for resident use were observed to be maintained and able to meet the needs of the residents at this time.
Based on a review of the forms and documents obtained during this investigation, it was learned that resident assessments were performed quarterly in order to address any changes to the needs and services that had to be updated with the residents. It was also learned that additional assessments and appraisals were performed when a resident was sent out to the hospital with new orders from their attending physician in order to address any new changes to their conditions. It was learned that these incidents of hospitalization or residents being sent out were duly reported to CCL within the allotted time frames.
It was learned that any changes were then also reported to the resident, and their responsible parties, so that the change in level of care could be discussed at that time.
Based on a review of the forms and documents obtained during this investigation, it was learned that there were designated residents who required assistance with showers, toileting, and other Activities of Daily Living (ADLs) from assigned facility staff. It was observed that these tasks and duties were assigned and fulfilled by facility staff for each shift throughout the day.

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

There were no deficiencies observed or cited at this time.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2