392701576-3-24-2026-27-AS-LKIG-DT4RVA-20260413132112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392701576
Report Date: 03/24/2026
Date Signed: 03/24/2026 09:53:37 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
01/28/2026 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20260128081241

FACILITY NAME:	CRYSTAL CREEK SENIOR LIVING		FACILITY NUMBER:	392701576
ADMINISTRATOR:	ANGELA RINGU		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS ROAD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 69	DATE:	03/24/2026
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Angela Riungu		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff do not assist resident with adequate supervision, resulting in resident unclothed in facility and/or smoking inside of facility.
Resident Rights are violated; Staff inappropriately speaks to resident, humiliate resident and/or interact inaapropriately.
Staff do not maintain a comfortable temperature in the facility for residents in care.
Staff do not distribute residents' medications as prescribed.
Staff confined resident to room.
Staff do not safeguard resident's mail
Staff do not serve residents food of good quality
Staff do not have medication training

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kesha Lewis and Melina Oropeza arrived unannounced to deliver findings for the above allegations. LPA met with Angela and explained the purpose of the visit.

Allegation 1: Staff do not assist resident with adequate supervision, resulting in resident unclothed in facility and/or smoking inside of facility is UNSUBSTANTIATED, based on interviews and observations no residents were unclothed.

Allegation 2: Resident Rights are violated; Staff inappropriately speaks to resident, humiliate resident and/or interact inaapropriately. Baed on obersvation over mulitlple visit LPA never heard or saw any staff interact inaapropriately with residents.

Allegation 3: Staff do not maintain a comfortable temperature in the facility for residents in care this alleagaton is UNSUBSTANTIATED based on interviews and abservations no resdients stated there were uncomfterbale with the tempiture and over muliple visits the LPA observed the facility to be with in the required tempature range.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

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 4

Control Number 27-AS-20260128081241

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: CRYSTAL CREEK SENIOR LIVING	FACILITY NUMBER: 392701576
	VISIT DATE: 03/24/2026

NARRATIVE

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Allegation 4: Staff do not distribute residents' medications as prescribed is UNSUBSTANTIATED, based on records reviewed R1 received all medication that was prescribed to them.

Allegation 5: Staff confined resident to room is UNSUBSTANTIATED, based on interview with reporting party. They stated on multiple occasions they leave the facility to go to the taco truck and based on observation when LPA arrived at the facility R1 was outside in the parking lot with other residents.

Allegation 6: Staff do not safeguard resident's mail is UNSUBSTANTIATED, based on interviews with staff there is only one person that handles mail for the facility and they pass the mail out to the residents.

Allegation 7: Staff do not serve residents food of good quality is UNSUBSTANTIATED, based on observations and records reviewed the facility is providing food that is within regulation.

Allegation 8: Staff do not have medication training is UNSUBSTANTIATED, based on records review all staff that handle medication has the required training.

A finding that the complaint allegation 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 occurred.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
01/28/2026 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260128081241

FACILITY NAME:	CRYSTAL CREEK SENIOR LIVING		FACILITY NUMBER:	392701576
ADMINISTRATOR:	ANGELA RINGU		FACILITY TYPE:	740
ADDRESS:	2435 WAGNER HEIGHTS ROAD		TELEPHONE:	(209) 477-5353
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95209
CAPACITY:	80	CENSUS: 69	DATE:	03/24/2026
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Angela Riungu		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff do not answer resident's call button in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kesha Lewis and Melina Oropeza arrived unannounced to deliver findings for the above allegations. LPA met with Angela and explained the purpose of the visit.

Based on multiple interviews with residents where it was stated they had to wait over 30 minutes for a response the allegation staff do not answer resident's call button in a timely manner is SUBSTANTIATED.

Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations is being cited on the attached LIC 9099D. Appeal Rights have been provided and an exit interview with Angela was conducted to discuss these finding.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20260128081241

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: CRYSTAL CREEK SENIOR LIVING	FACILITY NUMBER: 392701576
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/24/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/25/2026 Section Cited CCR 87464(f)(1)	1 2 3 4 5 6 7	87464(f)(1) Basic Services: Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: based on interviews and file review.	1 2 3 4 5 6 7	The facility has already updated there call button system and each resident now has a pendent they wear and additionial training has been compleated and the time is now able to be seen.
	8 9 10 11 12 13 14	the Licensee did not ensure staff were responding to residents call buttons timely and providing care in a timely manner. This posed a potential health and safety risk.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 03/24/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4