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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701370
Report Date: 08/12/2026
Date Signed: 08/12/2026 01:32:58 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
06/17/2026 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20260617111308
FACILITY NAME:BETHEL PLACE ASSISTED LIVING 2FACILITY NUMBER:
392701370
ADMINISTRATOR:NWAOGU, PRINCEWILLFACILITY TYPE:
740
ADDRESS:9738 NORTHSTAR CTTELEPHONE:
(925) 202-8447
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY:6CENSUS: 4DATE:
08/12/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Princewill NwaoguTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff did not reorder residents medications timely resulting in resident missing medications
INVESTIGATION FINDINGS:
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On 8-12-2026 at 10:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation for the allegation noted above. LPA met with Administrator Princewill Nwaogu and explained the purpose of the visit. During this investigation, LPA conducted interview with Administrator and reviewed facility file documentation including medication log sheets and physician's report for resident1 (R1).

Allegation: Staff did not reorder residents medications timely resulting in resident missing medications. LPA conducted interview and record reviews as noted above. Based on interview and record reviews, it was determine that resident1 (R1) was admitted to facility on 4-13-2026 with orders for two diabetic medications. A review of medication log sheets indicated R1 was without one diabetic medication between 4/30/2026 to 6/9/2026 and filled on 6/10/2026. It was also revealed that R1 was without a second diabetic medication between 5/29/2026 and 6/8/2026 and filled on 6/9/2026. Interviews and record reviews further revealed that ordering of medication commenced on or about 6/2/2026. No further evidence existed to show earlier attempts at re-ordering medication. {Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
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 3
Control Number 27-AS-20260617111308
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: BETHEL PLACE ASSISTED LIVING 2
FACILITY NUMBER: 392701370
VISIT DATE: 08/12/2026
NARRATIVE
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Additionally, interviews revealed that Licensee did not ensure R1 was seen for emergency services despite knowledge of medication not available for the time frames mentioned above. As a result, there is a preponderance of evidence to conclude that Licensee did not ensure the timely ordering of medication resulting in missed medication for R1, therefore this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6, and noted on LIC 9099D. An exit interview was conducted with Administrator and a copy of this report was provided. Appeal rights and LIC 811 provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260617111308
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: BETHEL PLACE ASSISTED LIVING 2
FACILITY NUMBER: 392701370
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2026
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement was not met as evidence by:
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Licensee will develop and submit a plan outlining procedures to ensure timely ordering of medication and overall assurance of medication availablity for residents in care. Plan to be submitted to LPA by POC due date.
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Based on interview and record review, Licensee did not ensure the assistance of medications for R1 in that R1 ran out of medications without the timely ordering to ensure availability. This posed an immediate health and safety risk to resident 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.
SUPERVISOR'S NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3