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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345003013
Report Date: 09/10/2026
Date Signed: 09/10/2026 03:06:42 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
09/03/2026 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20260903162352
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: 6DATE:
09/10/2026
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Suimranjit BhatiaTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff does not ensure that facility is not free of debris.
INVESTIGATION FINDINGS:
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Licensing Program Anlayst (LPA) Cassie Yang arrived at the facility to open the allegation of the complaint listed above. LPA met with Administrator and explained the purpose of the visit.

During today's investigation, LPA and Administrator conducted a tour of the interior and exterior of the facility. Based on observation, LPA observed a full bed frame to be in the front yard by the front door. LPA observed the backyard to have a screen door, bed padding, boxes of trash and wheelchair on the pathway to the emergency exit. Photos were taken of the following. Based on LPA's observations, allegation, Staff does not ensure that facility is not free of debris, is substanitated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegation cited above is substantiated, please see LIC9099-D.

Exit interview conducted and a copy of the report and appeal rights was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
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)
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Control Number 59-AS-20260903162352
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: 09/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2026
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Licensee is to schedule a trash pick up for all the debris that is left at the facility. Bed frame in the front yard is to be removed; boxes of trash, broken door screens, wheelchair, mattresses and paddings are to be removed from the backyard.
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This requirement is not met as evidenced by: Based on observation, Licensee did not comply as LPA observed bed frame in the front yard; wheelchair, door screens, bed mattresses and padding, boxes in the backyard which obstruct pathway which poses an potential risk for residents in care.
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Proof of removal is to be submitted to Licensing by September 18, 2026.

Failure to correct by due date may result to $100 per day until corrected.
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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: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

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

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