<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701183
Report Date: 05/20/2026
Date Signed: 05/20/2026 11:06:15 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
11/24/2025 and conducted by Evaluator Noel Wolf Petersen
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251124143630
FACILITY NAME:STAR BLOOM CAREHOMEFACILITY NUMBER:
392701183
ADMINISTRATOR:ACUAVERA, ARLENEFACILITY TYPE:
735
ADDRESS:2410 LAGUNA CTTELEPHONE:
(209) 641-9320
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 5DATE:
05/20/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Emilia BaguinonTIME COMPLETED:
09:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent a client from sustaining a fracture while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
~ Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility to deliver findings of a department report investigating a complaint with the above allegations. LPA met with substitute administrator Emilia Baguinon, designated representative of Starbloom Care Home via LIC 308 to explain the purpose of the visit.
~ The report finds insufficient evidence to support a lack of care resulted in a resident sustaining a fracture. Resident was unable to provide a statement as to how the injury occured. File review records indicate medical conditions which may or maynot have contributed to the injury. Interviews were conducted with facility staff. There was no indication of witnessed or unwitnessed falls. It was unclear how resident sustained the fracture. Due to the lack of evidence in establishing how the resident sustained this injury, this allegation is Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
~ A copy of the report was read and given to the substitue administrator. Appeal rights provided. Exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026
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 1