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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345003013
Report Date: 09/30/2026
Date Signed: 09/30/2026 01:48:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2025 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20251110135332
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: 3DATE:
09/30/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Simranjit Bhatia, AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff neglect resulted in resident death.
Facility gave false information regarding resident's condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with XXX during today’s investigation.
LPA investigated allegation, “Staff neglect resulted in resident death”. Relevant party reported R1 passed away due to staff neglect. After hospitalization, R1 was discharged to a different facility on 2/10/25 on hospice services and passed away 3 days later. The department reviewed facility documentation, hospital records, and conducted interviews. The death certificate was reviewed as part of the investigation. The death certificate identified a medical condition as the cause of death. The specific medical diagnosis is confidential and is not disclosed in this report. The Department substantiated on 10/28/25 that neglect by facility staff contributed to R1’s hospitalization on February 5, 2025, due to a severe coccyx pressure ulcer and suspected dehydration leading to acute kidney injury. The facility failed to assess their capacity and capability to care for R1, even with home health support.
Continue on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
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 59-AS-20251110135332
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: ANGELS ASSISTED LIVING,INC.
FACILITY NUMBER: 345003013
VISIT DATE: 09/30/2026
NARRATIVE
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The facility failed to coordinate with home health care for R1's needs to address R1's pressure injury, and transfer R1 to a higher level of care. In addition, on 10/28/25 the department determined that the facility did not consistently implement pressure injury prevention and wound care measures as directed by home health nurse. This failure resulted in R1 developing a Stage 4 pressure injury to the coccyx, as well as a worsening pressure injury to the right heel. Hospital records reviewed had no indication of respiratory failure when R1 was discharged from the hospital and hospice records were unavailable for review. Based on the investigation and review of the death certificate there is not enough evidence to support R1’s death was a direct result of staff neglect. Allegation is found to be UNSUBSTANTIATED.
LPA investigated, “Facility gave false information regarding resident's condition.” LPA interviewed an identified witness for R1 in which they stated facility gave them false information regarding resident's condition. The Witness stated that the licensee would report to them that resident would be eating well and drinking a good amount of water. Licensee would report to them that residents were doing well and there were no issues. Once R1 was hospitalized, the witness learned that the hospitalization was for a serious medical condition. Witness stated that R1 also lost weight. Witness stated the facility was lying to them about the residents’ condition and giving false information. No written facility documentation was available concerning R1’s care, food intake, or water intake. Administrator reported that R1 was eating with the assistance of care staff and water was provided to R1 throughout the day with assistance from staff. Due to the conflicting information gathered, LPA finds allegation to be unsubstantiated.
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.
Copy of report provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2025 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20251110135332

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: 3DATE:
09/30/2026
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Simranjit Bhatia, AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility failed to inform responsible party of resident's change in condition.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint fidnings. LPA met with administrator, Simranjit Bhatia, during today's inspection.
LPA investigated, “Facility failed to inform responsible party of resident's change in condition”. The department investigated allegation on 10/28/25 on complaint #59-AS-20250207161111. Based on records reviewed, the records revealed on February 5, 2025, R1 was transported to the hospital via 911 due to a severe coccyx pressure injury. The investigation determined that the facility did not notify the responsible party, or any family members, of the hospitalization. Family members were informed by the hospital that R1 was admitted to the hospital. Based on the information gathered, above 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.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20251110135332
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: ANGELS ASSISTED LIVING,INC.
FACILITY NUMBER: 345003013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2026
Section Cited
CCR
455445
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Reappraisals. (f)The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident’s record. This requirement is not evidenced by:
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Facility was cited on same allegation on 10/29/25 and POC was submitted into CCL. No further POC is needed.
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Based on interviews and record review, the licensee failed to notify R1’s responsible party when R1 was admitted to the hospital. This poses an immediate Health and Safety risk to resident 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: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4