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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 095920187
Report Date: 09/10/2026
Date Signed: 09/10/2026 11:22:55 AM

Unsubstantiated


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
05/27/2026 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20260527094708
FACILITY NAME:PAVILION AT EL DORADO HILLS, THEFACILITY NUMBER:
095920187
ADMINISTRATOR:DELGADO, KIMBERLYFACILITY TYPE:
740
ADDRESS:2288 FRANCISCO DRTELEPHONE:
(916) 542-3452
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:64CENSUS: 62DATE:
09/10/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Kim DelgadoTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff do not ensure residents bathing needs were met
Staff did no safeguard resident's personal belongings
Staff did not ensure that resident received laundry services
Residents' sustain injuries due to staff neglect or physical abuse
Licensee did not ensure egress doors were properly working
Staff do not respond to residents calls in a timely manner
Staff did not dispose of resident's trash bin
Staff are chemically restraining residents
INVESTIGATION FINDINGS:
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On 9/10/2026, Licensing Program Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Kim Delgado.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
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 3
Control Number 59-AS-20260527094708
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: PAVILION AT EL DORADO HILLS, THE
FACILITY NUMBER: 095920187
VISIT DATE: 09/10/2026
NARRATIVE
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Staff did not ensure residents' bathing needs were met.
During the investigation, the LPA reviewed facility documentation and conducted interviews with staff regarding residents' bathing needs. The documentation reviewed indicated that staff offered bathing assistance and that the resident refused shower assistance on multiple occasions. Staff documented the resident's refusals.
Although staff could have made additional attempts to encourage the resident to accept shower assistance, the evidence obtained established that bathing assistance was offered and the resident's refusals were documented. The investigation did not establish that staff failed to provide the resident with the opportunity to receive bathing assistance. Based on the totality of the evidence obtained, the allegation is UNSUBSTANTIATED.
Staff did not safeguard the resident's personal belongings.
During the investigation, the LPA conducted interviews and reviewed available facility documentation regarding the resident's personal belongings and valuables. The investigation established that the resident's family reported that items of the resident's clothing were missing. However, the missing clothing items were not documented on the resident's Property and Valuables form. The available documentation did not establish that the specific clothing items reported as missing were present at the facility or were received by the facility for safekeeping. Due to the lack of documentation identifying the missing items on the Property and Valuables form, the investigation was unable to establish that the facility had possession or responsibility for safeguarding the specific items reported missing. Based on the totality of the evidence obtained, there was insufficient evidence to establish by a preponderance of the evidence that staff failed to safeguard the resident's personal belongings. Therefore, the allegation is UNSUBSTANTIATED.
Staff did not ensure residents received laundry services.
During the investigation, the LPA reviewed available facility documentation and conducted interviews regarding residents' laundry services. The evidence obtained established that laundry services were provided to residents. The investigation also identified reports that multiple items of residents' clothing went missing. As a result, the residents' family began providing laundry services. However, the evidence obtained did not establish that the facility failed to provide laundry services to the residents. Based on the totality of the evidence obtained, the allegation is UNSUBSTANTIATED.
Residents sustained injuries due to staff neglect or physical abuse.
During the investigation, the LPA conducted interviews and reviewed available facility documentation regarding the alleged injuries. The evidence obtained did not establish a preponderance of evidence demonstrating that residents' injuries were caused by staff neglect or physical abuse. The information obtained through interviews and documentation reviewed did not provide sufficient corroborating evidence to establish that staff intentionally caused injury or that the injuries resulted from staff neglect. Based on the totality of the evidence obtained, the allegation that residents sustained injuries due to staff neglect or physical abuse is UNSUBSTANTIATED.
CONTINUE ON PAGE 2 ...
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20260527094708
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: PAVILION AT EL DORADO HILLS, THE
FACILITY NUMBER: 095920187
VISIT DATE: 09/10/2026
NARRATIVE
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PAGE 2 ...
Licensee did not ensure egress doors were properly functioning.
During the investigation, the LPA reviewed information regarding the facility's egress doors and conducted interviews with facility representatives. The investigation established that the facility experienced issues with its egress doors. However, evidence obtained demonstrated that the facility contacted the appropriate parties to address the identified issues and took action to have the doors repaired. Based on the evidence obtained, the investigation did not establish that the licensee failed to take appropriate action to address the identified egress-door concerns. Therefore, the allegation is UNSUBSTANTIATED.
Staff did not respond to residents' calls in a timely manner.
During the investigation, the LPA conducted interviews with relevant staff and residents and reviewed available documentation regarding residents' calls for assistance. The evidence obtained did not establish sufficient evidence demonstrating that staff failed to respond to residents' calls in a timely manner. The investigation did not establish a consistent pattern of delayed responses or that staff knowingly failed to respond to residents' requests for assistance. Based on the totality of the evidence obtained, the allegation is UNSUBSTANTIATED.
Staff did not dispose of residents' trash.
During the investigation, the LPA reviewed information regarding the disposal of residents' trash and conducted observations of the facility. The investigation identified information indicating that residents' trash may not have been removed on some occasions. However, during multiple Department walkthroughs, the LPA observed that trash had been removed from residents' rooms and that residents' rooms were maintained without accumulated trash. Based on the totality of the evidence obtained, the investigation did not establish that staff failed to routinely dispose of residents' trash. Therefore, the allegation is UNSUBSTANTIATED.
Staff chemically restrained residents.
During the investigation, the LPA reviewed available resident records, medication documentation, and facility records and conducted interviews with relevant individuals regarding the allegation of chemical restraint. The investigation did not identify sufficient evidence to establish that staff administered medication to residents for the purpose of controlling behavior or restricting residents' movement in a manner constituting chemical restraint. Based on the records reviewed and interviews conducted, the preponderance of evidence did not establish that staff chemically restrained residents. Therefore, the allegation is UNSUBSTANTIATED

Exit interview conducted. Report left with facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3