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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803815
Report Date: 04/17/2025
Date Signed: 05/01/2025 12:14:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/21/2025 and conducted by Evaluator Jill Nakagawa
COMPLAINT CONTROL NUMBER: 21-AS-20250121132607
FACILITY NAME:AMERICAN ASSISTED LIVINGFACILITY NUMBER:
486803815
ADMINISTRATOR:SUKHJIT SANDHUFACILITY TYPE:
740
ADDRESS:405 KINGS WAYTELEPHONE:
(510) 604-3825
CITY:SUISUN CITYSTATE: ZIP CODE:
94585
CAPACITY:30CENSUS: 21DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sukhjit Sandhu, LicenseeTIME COMPLETED:
02:52 PM
ALLEGATION(S):
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Unlawful Eviction
Personal Rights
INVESTIGATION FINDINGS:
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****This is an amended report***
On April17, 2025, Licensing Program Analyst (LPA) Nakagawa arrived unannounced for the purpose of delivering complaint investigation findings regarding the above allegations and was greeted by Licensee Sukhjit Sandhu.. LPA Nakagawa toured the facility, conducted interviews, reviewed records, and made observations during the course of the investigation.

The complaint alleges that resident (R1) was illegally evicted. The complainant states that the Licensee called the family of R1 stating that R1 had not paid and needed to move out in three days. LPA interviewed the Licensee who stated that they had contacted the family of R1 for payment but had not threatened to evict.

(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 2
Control Number 21-AS-20250121132607
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: AMERICAN ASSISTED LIVING
FACILITY NUMBER: 486803815
VISIT DATE: 04/17/2025
NARRATIVE
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Continued on 9099-C

LPA requested documents for R1, including a signed Admissions Agreement, pre- assessment, a physician’s report and billing statements. The Licensee was unable to provide any documentation, including an eviction notice or any evidence that R1 had been given an eviction notice. LPA contacted R1’s family members (I1, I2) who did not have any supporting evidence of an admissions agreement or eviction paperwork. Based on lack of records and through interviews R1 had the ability to make their own decisions therefore the allegations of an illegal eviction and vioation of personal rights is unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2