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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 525001919
Report Date: 11/13/2025
Date Signed: 11/13/2025 10:00:23 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
10/29/2025 and conducted by Evaluator Rebecca Knight
COMPLAINT CONTROL NUMBER: 59-AS-20251029154431
FACILITY NAME:ALOHA HOUSEFACILITY NUMBER:
525001919
ADMINISTRATOR:NGUYEN, MAIFACILITY TYPE:
740
ADDRESS:13765 LISA WAYTELEPHONE:
(530) 529-1052
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:6CENSUS: DATE:
11/13/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mai Nguyen - administratorTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff consume alcohol at the facility while on shift. - SUBSTANTIATED
INVESTIGATION FINDINGS:
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11/13/2025 109:30 AM Licensing Program Analyst (LPA's) Rebecca Knight and Marisa Chiarelli arrived at the facility unannounced to deliver the results of a complaint investigation. LPAs met with administrator Mai Nguyen and explained the purpose of the visit.

During the course of the investigation LPA interviewed the administrator, licensee, and two staff.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
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 59-AS-20251029154431
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ALOHA HOUSE
FACILITY NUMBER: 525001919
VISIT DATE: 11/13/2025
NARRATIVE
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It was reported that staff consume alcohol at the facility while on shift. Photographs were submitted with the complaint that show a television stand with an open door that reveals multiple alcohol bottles. No people are shown in any of the photographs. On 11/04/2025 LPA toured the facility and found two bottles of liquor in the staff room in a cabinet that matches the photograph that was submitted with the complaint. However, there are no witnesses as to who placed the alcohol in the staff room and no staff have been observed to be impaired while providing care to residents.

It was determined that while touring the facility on 11/04/2025 LPA found alcohol in a cabinet in the staff room. No staff claim responsibility for placing the alcohol in the staff room. All persons interviewed stated that they have not witnessed any staff or the administrator to be impaired while providing care to the residents. However, the fact that alcohol is in the staff room indicates that it is being consumed while the user is in the facility. This allegation is substantiated.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. Exit interview conducted and a copy of the report was provided to administrator Mai Ngyuen.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20251029154431
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ALOHA HOUSE
FACILITY NUMBER: 525001919
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2025
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements-General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:
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Licensee agrees to hold in-service training with all staff to review the facility's drug and alcohol policy. Licensee agrees to submit staff sign-in sheet and written confirmation of training completion to CCL by POC date to clear the deficiency.
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Based on interviews and observation, the licensee failed to ensure that staff are not consuming alcohol while they are in the facility which poses an immediate risk to residents in care.
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POC due 11/27/2025.
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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.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3