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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700701
Report Date: 08/28/2025
Date Signed: 08/28/2025 04:00:17 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
05/07/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20250507163336
FACILITY NAME:ASIANA RESIDENTIAL SERVICESFACILITY NUMBER:
502700701
ADMINISTRATOR:KHAN, SAJIDAFACILITY TYPE:
735
ADDRESS:5020 TAMARA WAYTELEPHONE:
(209) 566-3933
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:6CENSUS: 6DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Sabrina Sanchez TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately groomed a resident without consent
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jason Lund arrived unannounced to amend a complaint investigation regarding the above allegation. LPA Lund met with Administrator Sabrina Sanchez and explained the reason for the visit. On 8/28/2025 LPA Lund ameded the complaint Deficiency page.
Staff inappropriately groomed a resident without consent- LPA Lund reviewed facility paperwork and interviewed staff, reporting party and witnesses. LPA Lund reviewed facility paperwork and IPP’s for Client (C1) and Client (C2). Both clients are nonverbal and cannot give consent for any type of grooming. The facility didn’t have a formal Individual Development Team meeting before they groomed both clients.
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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
Control Number 27-AS-20250507163336
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: ASIANA RESIDENTIAL SERVICES
FACILITY NUMBER: 502700701
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
08/29/2025
Section Cited
CCR
80072(a)(3)
1
2
3
4
5
6
7
Each client has the right to be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions...
1
2
3
4
5
6
7
Administrator Sabrina Sanchez will have a training on Personal Rights and email a copy of the training.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Based on both clients are nonverbal and cannot give consent for any type of grooming.
Which possess an immediate health and safety risk for residents in care.
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: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20250507163336
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: ASIANA RESIDENTIAL SERVICES
FACILITY NUMBER: 502700701
VISIT DATE: 08/28/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on reviewed facility paperwork and interviews with staff, and reporting party the information provided, it clear that staff inappropriately groomed a resident without consent therefore the allegation was deemed SUBSTANTIATED.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

Exit interview was conducted, and copies of the report and appeal rights left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3