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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700461
Report Date: 04/28/2025
Date Signed: 04/28/2025 02:04:28 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
02/27/2025 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20250227092110
FACILITY NAME:KIRSTEN COURT CARE HOMEFACILITY NUMBER:
392700461
ADMINISTRATOR:QURESHI, MUHAMMADFACILITY TYPE:
735
ADDRESS:2553 KIRSTEN COURTTELEPHONE:
(209) 224-1946
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY:4CENSUS: 3DATE:
04/28/2025
UNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Muhammad QuereshiTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff are overmedicating the client
INVESTIGATION FINDINGS:
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On 4-28-2025 at 1:04pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the allegation noted above. LPA met with Administrator Muhammed Quereshi and explained the purpose of the visit. During this investigation, LPA conducted interviews with four staff members and one resident. Additionally, LPA reviewed facility file documentation including medication log sheets, facility care notes, individual program plan (IPP), and individual service plan pertaining to resident1 (R1). LPA also conducted a brief observation of medication storage area. Based on record review, interview, and observation, it was determined that R1 received three medications as ordered. Record reviews indicated R1 was assisted with medication by staff as ordered and on time with no additional dosages given. Furthermore, it was determined that no additional medications existed for R1 outside of R1's regularly prescribed medication within facility and available to R1.

{Cont. on 9099C}
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
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-20250227092110
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: KIRSTEN COURT CARE HOME
FACILITY NUMBER: 392700461
VISIT DATE: 04/28/2025
NARRATIVE
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As a result, there is not a preponderance of evidence to conclude staff overmedicated R1, therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Administrator and a copy of this report was provided. Appeal rights provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2