342700018-8-12-2026-27-AS-SRIN-DXKTXZ-20260903150758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700018
Report Date: 08/12/2026
Date Signed: 08/12/2026 12:05:55 PM

Unsubstantiated

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
01/06/2026 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20260106124813

FACILITY NAME:	GROVE HOME CARE		FACILITY NUMBER:	342700018
ADMINISTRATOR:	BOBOC, LUCIA		FACILITY TYPE:	740
ADDRESS:	8410 TERRACOTTA CIRCLE		TELEPHONE:	(916) 225-6405
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 6	DATE:	08/12/2026
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Lucia Boboc		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Illegal eviction
Staff did not provide adequate supervision, resulting in resident sustaining a fracture

INVESTIGATION FINDINGS:

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On August 12, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility to conduct an unannounced investigation visit and deliver findings of the allegations noted above. LPA initially met with staff on duty and stated the purpose of the visit. The adminsitrator, Lucia Boboc (AD), was notified and arrived shortly after.

Overview: It was alleged that the facility did not adequately supervise Resident-1 (R1) while taking antibiotics that caused R1 to be sleepy and required extra water. They say staff did not help R1 into bed, did not lift legs in wheelchair, and did not make sure R1 drank enough, which led to R1 falling from the wheelchair and breaking R1 leg. The Reporting Party (RP) also says that right after the injury, the administrator gave the family eviction notices and would not let R1 return, even though hospital staff and R1’s doctor said it was safe for R1 to go back with therapy. The RP believes the eviction notices were unfair, false, and done to bully or discriminate against R1.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

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 4

Control Number 27-AS-20260106124813

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: GROVE HOME CARE	FACILITY NUMBER: 342700018
	VISIT DATE: 08/12/2026

NARRATIVE

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Allegation – Illegal Eviction:
The investigation into this allegation consisted of interviews and record reviews.
On October 8, 2025, the POA for R1 reported that R1 was provided a 30-day eviction notice on September 10, 2025.
Email correspondence showed that Administrator Lucia asked LPA Sommer Hayes to review the eviction notice that was provided to R1. Per review, LPA Hayes provided consultation to Lucia to update R1’s reappraisal. On August 6, 2025, Lucia stated that a reappraisal had been conducted for R1 but that the family refused to sign it. Lucia also reported that the POA had not provided an updated Physician’s Report at that time.
The 30-day eviction notice cited Title 22, Section 87224(a)(4), and stated that R1’s care needs had increased beyond what the facility could safely provide. The notice documented that R1 required two caregivers and a Hoyer lift for transfers, had severe weaknesses, could not turn or reposition independently, and was at risk of falling or sliding from the lift. The notice also documented difficulty with personal care and administration of eye drops.
The notice further documented concerns regarding the POA’s lack of cooperation, including failure to provide updated medical documents and physician information and difficulty communicating with facility staff. The notice included resident rights, complaint information, and relocation resources. An addendum to the 30-day Notice, dated November 13, 2025, continued to document the facility’s concerns regarding R1’s care needs and the POA’s reported lack of cooperation.
Email correspondence between Lucia and the Department, dated January 22, 2026, showed that the POA voluntarily removed R1 from the facility. There is no evidence that the facility physically removed R1.
Based on the reviewed records, the facility documented R1’s increased care needs and stated that a reappraisal had been conducted before the eviction process. Although LPA Hayes later raised concerns regarding the initial eviction notice, the available evidence does not establish that the facility failed to conduct a reappraisal or that the facility unlawfully removed R1. The evidence shows that R1 was voluntarily removed by the POA.
The allegation of illegal eviction is UNSUBSTANTIATED. The evidence does not establish that the facility unlawfully evicted R1. The facility documented R1’s increased care needs, reported completion of a reappraisal, provided eviction-related rights and resources, and R1 was ultimately voluntarily removed by the POA.
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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20260106124813

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: GROVE HOME CARE	FACILITY NUMBER: 342700018
	VISIT DATE: 08/12/2026

NARRATIVE

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Allegation - Staff did not provide adequate supervision, resulting in resident sustaining a fracture
It is alleged that facility staff failed to provide adequate supervision to resident (R1), resulting in R1 sustaining a fracture. The investigation into this allegation consisted of interviews and record reviews.
Record reviews showed that on December 21, 2025, R1 fell and injured their left knee. Medical records stated that R1 fell from a wheelchair during a transfer when a caregiver assisting R1 slipped. R1 was transported by EMS to Emergency Department (ER). R1 was diagnosed with a left knee sprain and discharged the same day. The initial X-ray did not show a fracture.
On December 23, 2025, R1 returned to the ER due to continued left knee pain and delirium. A CT scan showed a fracture of the distal left femur. R1 was placed in a long leg splint and later followed up with orthopedics on January 7, 2026.
The facility incident report stated that on December 21, 2025, R1 was alone in their room when the fall occurred and that the fall was unwitnessed. Staff became aware of the incident shortly after it occurred, responded immediately, contacted EMS, notified responsible parties, and had R1 transported to the hospital. Fall precautions were implemented after R1 returned to the facility.
R1’s appraisal/needs service plans dated August 5, 2025, and September 4, 2025, documented that R1 had severe weakness, left-sided weakness from a prior stroke, and an increased risk of falls. The service plan stated that R1 required two caregivers for transfers and peri-care and sometimes slid from the lift because of weakness. The Physician’s Report dated November 10, 2023, also stated that R1 was non-ambulatory and unable to transfer independently.
The records establish that R1 had a known fall risk and sustained a fracture following a fall. However, the evidence does not establish that staff failed to provide the required supervision or failed to follow R1’s care needs at the time of the incident. There is also conflicting information regarding the circumstances of the fall. The facility reported that the fall was unwitnessed, while the medical record stated that a caregiver was assisting R1 when the caregiver slipped.
Further medical records show that staff obtained medical attention immediately after the fall. The fracture was not identified on the initial X-ray and was found two days later through a CT scan after R1 continued to experience knee pain.
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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 27-AS-20260106124813

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: GROVE HOME CARE	FACILITY NUMBER: 342700018
	VISIT DATE: 08/12/2026

NARRATIVE

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The allegation is UNSUBSTANTIATED. Although R1 sustained a distal left femur fracture after a fall, the available evidence does not establish that inadequate supervision by facility staff caused or contributed to the fall or fracture. Staff responded promptly, obtained medical attention, notified responsible parties, and reinforced fall precautions. Therefore, there is insufficient evidence to substantiate a violation related to inadequate supervision.

A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Administrator and a copy of this report was provided to Administrator. Appeal rights provided.

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SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

LIC9099 (FAS) - (06/04)

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