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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701159
Report Date: 06/16/2026
Date Signed: 06/16/2026 03:44:22 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
06/11/2026 and conducted by Evaluator Melina Oropeza
COMPLAINT CONTROL NUMBER: 27-AS-20260611121820
FACILITY NAME:BEATRICE SENIOR CAREFACILITY NUMBER:
342701159
ADMINISTRATOR:CLARK, TIMOTHYFACILITY TYPE:
740
ADDRESS:8901 MELODIC CTTELEPHONE:
(916) 270-3961
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 6DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Beatrice ClarkTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff mismanaged and mishandled resident(s) medications.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Melina Oropeza and Kesha Lewis arrived to the facility unannounced to conduct a complaint investigation visit. LPAs Oropeza and Lewis met with Licensee Beatrice Clark, and explained the purpose of the visit.

LPA Oropeza reviewed medications for three out of six residents and conducted medication counts for Residents (R1) (R2) (R3). During the review, discrepancies were identified between the medication counts and medications on hand. The Administrator stated the facility does not maintain Medication Administration Records (MARs), medication audit records, or a Centrally Stored Medication record. Due to the absence of required medication records and the medication count discrepancies identified, LPA verified medications were not properly accounted for.

see page C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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 27-AS-20260611121820
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: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
VISIT DATE: 06/16/2026
NARRATIVE
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Based on LPA observations, interview and medication count, the the preponderance of
evidence standard has been met, therefore the above allegation is found to be Substantiated.

Citations are being issued today per California Code of regulation Title 22 see 9099D page.

An exit interview was held, and a copy of this report and appeal rights was provided to administrator.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260611121820
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: BEATRICE SENIOR CARE
FACILITY NUMBER: 342701159
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/17/2026
Section Cited
CCR
87465(c)(2)
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87465(c)(2) Incidental Medical and Dental Care (c)If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met:
(2) Once ordered by the physician the medication is given according to the physician's directions.
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The licensee will create an excel spreadsheet for arrival medication count. The licensee will send proof of by 5:00pm on July 17, 2026.
The licensee provided the excel spreadsheet during the visit. No further POC is due at this time.
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Based on observations, interview and medication count, it is not clear if R1-R3 receive or were given mediations as prescibed by physicain.
Which poses an immediate health, safety, or
personal rights risk to persons in care.
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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.
SUPERVISOR'S NAME: Liza King
LICENSING EVALUATOR NAME: Melina Oropeza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3