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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920216
Report Date: 07/28/2026
Date Signed: 07/28/2026 03:13:45 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, 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
09/29/2025 and conducted by Evaluator Kerry Hiratsuka
COMPLAINT CONTROL NUMBER: 59-AS-20250929133313
FACILITY NAME:ROSE ARBOR VILLAGEFACILITY NUMBER:
345920216
ADMINISTRATOR:KLICK, GREGFACILITY TYPE:
740
ADDRESS:2001 ROSE ARBOR DRIVETELEPHONE:
(916) 216-8958
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:0CENSUS: 0DATE:
07/28/2026
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Health and Wellness Director Tammy Alves (HWD) TIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff do not ensure residents receive bathing service in a timely manner
Staff do not ensure residents medications are dispensed in a timely manner
Staff do not prevent residents from being left in soiled clothing
Licensee does not ensure the facility is kept free of pests
Staff do not ensure residents are provided meal service in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hiratsuka, conducted this visit to the facility to deliver final findings regarding a complaint that was received on 09/29/2025. The time frame of the allegations is prior to the complaint received by the department

Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegations listed above. Therefore, the allegations above are
unsubstantiated.

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

no deficiencies cited.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
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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