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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345003013
Report Date: 10/08/2026
Date Signed: 10/08/2026 01:21:50 PM

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
09/16/2026 and conducted by Evaluator Graham Gunby
COMPLAINT CONTROL NUMBER: 59-AS-20260916170419
FACILITY NAME:ANGELS ASSISTED LIVING,INC.FACILITY NUMBER:
345003013
ADMINISTRATOR:BHATIA, SIMRANJITFACILITY TYPE:
740
ADDRESS:1526 CRESTMONT OAK DRIVETELEPHONE:
(916) 841-9449
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:6CENSUS: 4DATE:
10/08/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator - SImranjit BhatiaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not have the proper training
INVESTIGATION FINDINGS:
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On 10/08/2026, Licensing Program Analyst (LPA) Graham Gunby arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator,
During the investigation LPA reviewed resident records, facility records and conducted interviews. LPA interviewed staff and residents during the visit. R1 stated they have observed staff change an ostomy bag with out being properly trained to do so. S2 who was independently working at the time, stated they have not changed the ostomy bag before and would need to call for assistance if it needed to be changed. During the visit on 09/24/2026, R1 stated they saw a caregiver watch a Youtube video while changing the ostomy bag because they were not trained by a skilled professional.
Based on the information obtained for the allegations above, the allegations are SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
Deficiencies cited on LIC809-D. Appeal rights provided. Exit interview conducted and a copy of the report is provided to Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2026
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 2
Control Number 59-AS-20260916170419
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: ANGELS ASSISTED LIVING,INC.
FACILITY NUMBER: 345003013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2026
Section Cited
CCR
87621(b)(1)(B)
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87621 Colostomy/Ileostomy
(b) In addition to Section 87611(b), the licensees shall be responsible for the following:(1) Ensuring that ostomy care is provided by an appropriately skilled professional.(B)There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of facility staff who have been instructed.
This requirement has not been met:
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Administrator agrees to submit a statement of understand for section 87621(b)(1)(B) and will submit to LPA Gunby by email before 11/06/2026.
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Based on LPA did not find proof that the staff was trained by a licensed professional to handle the ostomy bag, change or clean the area.
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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: Lauren Crocker
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2026
LIC9099 (FAS) - (06/04)
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