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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700864
Report Date: 04/10/2025
Date Signed: 04/10/2025 02:47:44 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
10/30/2024 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20241030163232
FACILITY NAME:SHELTERING ARMS LLCFACILITY NUMBER:
502700864
ADMINISTRATOR:DHILLO, JATINDERFACILITY TYPE:
735
ADDRESS:1112 TWILIGHT DRIVETELEPHONE:
(209) 535-7588
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY:4CENSUS: 4DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Jatinder Dhillon, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate supervision due to lack of staff
Staff are not able to communicate with residents due to language barrier
Staff did not keep resident's records confidential
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/10/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to present findings for a complaint. LPA Campbell met with Jatinder Dhillon, Administrator and explained the purpose of the visit.

Regarding the allegation that staff did not provide adequate supervision due to lack of staff, Per Staff 5(S5), “sometimes there werent enough staff" because of the behaviors of clients who required 1 on 1 supervision. S2 reported that “there may be one staff left with 4 people” if other staff left or private staff left.

Regarding the allegation that staff are not able to communicate with residents due to language barrier, LPA Campbell observed S6 during interviews. When LPA Campbell asked S6 about what they liked to do, S6 stated "watch movies and read books". LPA Campbell then asked S6 to share some details about the last book they read or movie they saw. S6 paused and stated “I can’t”. LPA Campbell asked about their favorite movie and S6 stated, “I can’t." When speaking, S6 was also difficult to understand and
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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 4
Control Number 27-AS-20241030163232
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: SHELTERING ARMS LLC
FACILITY NUMBER: 502700864
VISIT DATE: 04/10/2025
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
LPA Campbell had to ask S6 to repeat themselves several times in order to understand them until LPA Campbell had to guess what they were saying based on context of the sentence. When asked about clients, S6 said a client could be aggressive and LPA Campbell guessed at the word then meant to say.

Regarding the allegation that staff did not keep resident's records confidential, using interviews and document reviews, LPA Campbell compared statements provided by other parties to private information found in a resident's MAR and found that they matched and proved that someone outside of the facility had knowledge of a residents medical information.

Based on LPA’s interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.


Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are being cited on the attached 809-D during this visit. 
An exit interview was conducted and copies of the report and appeal rights left. 
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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
10/30/2024 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20241030163232

FACILITY NAME:SHELTERING ARMS LLCFACILITY NUMBER:
502700864
ADMINISTRATOR:DHILLO, JATINDERFACILITY TYPE:
735
ADDRESS:1112 TWILIGHT DRIVETELEPHONE:
(209) 535-7588
CITY:CERESSTATE: CAZIP CODE:
95307
CAPACITY:4CENSUS: 4DATE:
04/10/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Jatinder Dhillon, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/10/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to present findings for a complaint. LPA Campbell met with Jatinder Dhillon, Administrator and explained the purpose of the visit.

Regarding the allegation that staff did not safeguard resident's personal belongings, Staff 5 (S5) reported that “sometimes the laundry can be mixed up but that’s resolved by the middle of the day. I cant say anyone’s belongings have been mistreated. When asked if they had heard or seen if other residents belonging had been taken or destroyed, R1 stated no. And S3 reported that “I’ve never
heard about any resident’s belongings being destroyed. Its usually because residents have destroyed it.”

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given to Jatinder Dhillon
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
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-20241030163232
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: SHELTERING ARMS LLC
FACILITY NUMBER: 502700864
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2025
Section Cited
CCR
80078(a)
1
2
3
4
5
6
7
80078(a) Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
In the event additional staff is needed for 1 on 1 supervision, licensee will hire additional staff to be present all day.The licensee will provide a written memo of understanding regarding 80078 (a) and provide an LIC500 to clarify staffing for the facility by the POC due date.
8
9
10
11
12
13
14
Based on interviews, S5 and S2 reported incidents when there weren’t enough staff which poses an immediate health, safety and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type A
04/18/2025
Section Cited
CCR
80072(a)(1)
1
2
3
4
5
6
7
80072(a)(1) (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons…This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The licensee will provide a written memo of understanding regarding 80072(a)(1)conduct an in service for all staff on HIPAA and Management of Assaultive Behavior to provide opportunities for staff to practice english skills and licensee will .
8
9
10
11
12
13
14
Based on interviews, the licensee did not ensure all staff (S6) were able to speak fluent English and client information (R4) was not kept confidential which poses a potential health, safety or personal rights risk
8
9
10
11
12
13
14
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: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4