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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700908
Report Date: 05/26/2026
Date Signed: 05/26/2026 03:31:44 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
05/22/2026 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260522125335
FACILITY NAME:ST. TIMOTHY'S HOMEFACILITY NUMBER:
392700908
ADMINISTRATOR:ALMENDRALA, MARIAFACILITY TYPE:
740
ADDRESS:9230 LARIAT LANETELEPHONE:
(650) 267-3248
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:6CENSUS: 4DATE:
05/26/2026
UNANNOUNCEDTIME BEGAN:
02:13 PM
MET WITH:Avia SinghTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee did not follow proper eviction protocols with resident in care.
INVESTIGATION FINDINGS:
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On 05/26/2026, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to open the complaint for this facility.

Based on the information obtained, the allegation that the facility engaged in unsafe discharge practices, failed to coordinate continuity of care, and refused to accept R1 back into the facility is substantiated.

The preponderance of evidence supports that the facility failed to follow required discharge and eviction procedures, failed to coordinate continuity of care, and refused to accept R1 back into the facility following ED evaluation. Therefore, the allegation is substantiated. A deficiency will be cited on the LIC 9099D page.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
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-20260522125335
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: ST. TIMOTHY'S HOME
FACILITY NUMBER: 392700908
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2026
Section Cited
CCR
87422(a)
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"(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)." This requirement was not met as evidenced by:
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Licensee has already conferred with CCLD regarding future notices. Licensee agrees to pick-up R1 after equipment is sent to the facility
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Based on record review and interviews, R1 was given an unlawful eviction notices, which poses a potential health, safety, and/or personal rights risk.
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and will provide LPA with a written statement acknowledging 22 CCR eviction procedures.
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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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2