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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701052
Report Date: 08/05/2025
Date Signed: 08/06/2025 02:04:44 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
05/06/2025 and conducted by Evaluator Kesha Lewis
COMPLAINT CONTROL NUMBER: 27-AS-20250506103832
FACILITY NAME:ELIZABETH CARE HOMEFACILITY NUMBER:
392701052
ADMINISTRATOR:FAJARDO, GERALDINEFACILITY TYPE:
735
ADDRESS:3674 POPOLO CIRCLETELEPHONE:
(510) 289-3848
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:6CENSUS: 4DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:FAJARDO, GERALDINETIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff are having inappropriate discussions with clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to deliver findings for the above allegations. LPA Lewis met with facility staff and explained the purpose of the visit.


Based on interviews with staff and clients there was a dussision between staff and clients that was sexual in nature therefore the allegation Staff are having inappropriate discussions with clients is SUBSTANTIATED.
A finding of substantiated means that the preponderance of evidence standard has been met.

Citations are being issued from the California Code of Regulations, Title 22, Division 6.

An exit interview was conducted and a copy of this report and appeal rights were given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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 3
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
05/06/2025 and conducted by Evaluator Kesha Lewis
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250506103832

FACILITY NAME:ELIZABETH CARE HOMEFACILITY NUMBER:
392701052
ADMINISTRATOR:FAJARDO, GERALDINEFACILITY TYPE:
735
ADDRESS:3674 POPOLO CIRCLETELEPHONE:
(510) 289-3848
CITY:STOCKTONSTATE: CAZIP CODE:
95212
CAPACITY:6CENSUS: 4DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:FAJARDO, GERALDINETIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Staff forces client to take medication
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to deliver findings for the above allegations. LPA Lewis met with facility staff and explained the purpose of the visit.


Based on interviews conducted with 1 out of 4 residents and that residents family member also the administrator and behaviorist as well as documentation that was signed by the resident (R1) The allegation Staff forces client to take medication is found to be UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

No citations are bing issued.

An exit interview was conducted and a copy of report given.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250506103832
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: ELIZABETH CARE HOME
FACILITY NUMBER: 392701052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2025
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a) … each client shall have personal rights which include … (1) To be accorded dignity in his/her personal relationships with staff and other persons ...
This requirement was not met as evidenced by
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The Licensee has already conducted personal rights training for all staff and provided a copy of the traing to LPA.
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Based on interviews with staff and residents a conversation that was sexual in nature was held in a common area where all residents and staff could hear. This poses a potential health and safety risk to residents in care.
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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: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3