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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005120
Report Date: 08/28/2026
Date Signed: 08/28/2026 07:02:14 PM

Unsubstantiated


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
03/27/2026 and conducted by Evaluator Reza Jamaly
COMPLAINT CONTROL NUMBER: 27-AS-20260327084535
FACILITY NAME:D & C ELDERLY HOMEFACILITY NUMBER:
347005120
ADMINISTRATOR:CORINA DRAGNEAFACILITY TYPE:
740
ADDRESS:9474 RANCH PARK WAYTELEPHONE:
(916) 686-8312
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 4DATE:
08/28/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Corina DragneaTIME COMPLETED:
07:00 PM
ALLEGATION(S):
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Staff did not inform authorized representative of Hospice services for resident
Staff approved hospice services for resident without consent of the authorized representative
Unlawful eviction
Staff took resident off hospice without the consent of authorized representative
Staff did not allow authorized representative to use own hospice company for resident
INVESTIGATION FINDINGS:
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On 8/28/2026 at 9:30 AM Licensing Program Analyst (LPA) Reza Jamaly arrived unannounced at the facility to deliver investigation findings regarding allegations noted above. LPA met with staff on duty and explained the purpose of the visit. Administrator (AD) Corina Dragnea was notified and arrived shortly after.
To investigate the complaint, LPA conducted interviews, reviewed R1 records, subpoenaed and reviewed R1 hospice documents.

1. Staff did not inform authorized representative of Hospice services for resident.

Regarding above allegation, AD provided a written statement stating:
" RP was repeatedly informed and involved in communication concerning R1 change of condition, hospice evaluation, eligibility and possible enrolment. On 3/13/26, 3/16/26/,3/17/26,3/23/26 and 3/24/26 RP was informed when hospice initially indicated that R1 did not qualify for services and was subsequently informed when hospice determined that R1 did qualify.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
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 5
Control Number 27-AS-20260327084535
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: D & C ELDERLY HOME
FACILITY NUMBER: 347005120
VISIT DATE: 08/28/2026
NARRATIVE
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On 3/17/26, RP expressed support for R1 re-enrollment in hospice, on 3/24/26, RP expressed that RP is happy to hear that R1 qualified for hospice and confirmed that RP had received messages from the hospice RN".

LPA Jamaly observed text message from AD to RP sent on 3/13/26 at 1:43 PM, it reads " There is a change in R1 health, R1 seems weaker and refused to eat. I called the doctor and asked if R1 would be appropriate under hospice care. He thinks it is. What do you think? " RP Replied on 3/16/26 at 11:19 AM " yes… please proceed as you deem appropriate… thank you so much AD for knowing to follow up- I appreciated you so much!"

LPA observed a text message from AD sent to RP on 3/23/26 at 10:45 AM, it reads " we received a visit from hospice nurse again and told us that R1 DOES qualify for hospice service". RP replied on 3/24/26 at 7:PM, it reads " thank you for update and I am happy to hear this news- I hope you are also…".

During LPA's interview with RP on 8/14/26, RP stated that we talked about hospice verbally, S1 texted me that hospice agency is coming, I was expecting that all paperwork be coordinated before and be in writing.

LPA asked if RP was aware of communications between hospice agency and facility while R1 was on Blossom Ridge Hospice during 2024 and Sep 2025? RP stated yes, but they sent me discharged paper for signature and I signed it at last minute after they went under investigation for medical fraud and after they understood that paperwork should be signed.
On 8/21/2026 LPA Jamaly subpoenaed and reviewed R1 hospice paperwork from Blossom Ridge. Per Blossom Ridge Hospice Admission Service Agreement dated 1/13/2023, RP acknowledged and signed it as R1 authorized representative. Also, RP signed Hospice Benefit Election Form dated 1/13/2023 on behalf of R1, form is marked " Patient is Unable to Sign".

2. Staff approved hospice services for resident without consent of the authorized representative

LPA observed text message from AD sent to RP on 3/17/26 at 2 PM, it reads" we have not changed R1 to hospice, we were told R1 doesn't qualify for hospice as R1 doesn't have a terminal diagnosis" RP replied to AD on 3/17/26 at 3:32 PM, it reads " Whatever you want for R1 I support your decision- I was excited for a minute when you thought we might be able to put R1 back on hospice- I am glad the Dr. support that, thank you".

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260327084535
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: D & C ELDERLY HOME
FACILITY NUMBER: 347005120
VISIT DATE: 08/28/2026
NARRATIVE
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LPA observed text message from AD sent to RP on 3/17/26 at 7:40 PM, it reads" The nurse came to evaluate R1 and said R1 doesn't qualify for hospice at this time as R1 still eating and drinking but they will be open to come back if there will any significant changes".

LPA interviewed with RP regarding allegation above on 8/14/26. RP stated that everything had been arranged with hospice agency, they notified me at last minute and I refused to sign it because I was suspicious about this hospice agency. AD used this agency (Arias Hospice) for their other facilities as well.

LPA reviewed R1 records, per documents and interview with RP and AD, R1 has been in hospice for two times, first at Blossom Ridge Home from 1/13/2023 to 9/8/2025 and second time at Southern End Care Home from 4/11/2026 after release from D & C Elderly Home till end of R1's life. When LPA asked if allegation is about first or second time of hospice services, RP stated its about recent hospice agency (Arias Hospice) but the reason for enrolling and discharging R1 from previous hospice in 2025 (Blossom Ridge Home) is still unclear for me.
LPA subpoenaed and reviewed R1's documents from Blossom Ridge Home, per Admission Service Agreement dated 1/13/2023, RP acknowledged and singed it as R1 authorized representative.

Also, RP signed Hospice Benefit Election Form dated 1/13/2023 on behalf of R1, form is marked " Patient is Unable to Sign".

3.Unlawful eviction

LPA Jamaly reviewed R1 file and observed 30-day notice for relocation is emailed to RP on 3/25/2026 at 8:30 AM which is effective from 3/25/2026 to 4/23/2026. The reason for relocation is mentioned as R1 change of condition, after evaluation and being considered as bedridden since R1 room was not fired cleared for a bedridden resident.

LPA interviewed AD and reviewed written statement regarding this allegation, it states " my decision to issue the 30-day notice was because of R1 change of condition and the need for transfer to an appropriate setting if her needs could no longer be safely and legally accommodated in the room R1 occupied, which was not approved for a bedridden resident…I observed increasing changes in R1 functional abilities. R1 was spending substantially more time in bed, had increasing difficulty maintaining a seated position in wheelchair, became increasingly rigid and stiff, and required considerably more assistance with positioning and personal care.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20260327084535
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: D & C ELDERLY HOME
FACILITY NUMBER: 347005120
VISIT DATE: 08/28/2026
NARRATIVE
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There were times when R1 was unable to turn or reposition self in bed and staff had to turn R1 to provide incontinence care. I also observed difficulty reaching for items such as R1 drinking glass".

Per AD, R1 physician and hospice contacted regarding R1 change of condition, hospice was discussed during the 3/13/26 physician conduct, and a hospice nurse subsequently came to the facility and evaluated R1. The hospice admission was not completed because RP didn’t sign the hospice paperwork.
Per email sent to R1 physician on 4/9/26, AD asked R1 PCP to provide a written statement confirming R1 current condition as bedridden, provide any relevant medical assessment regarding R1 functional status, and any care recommendation or restriction.
R1 PCP responded to above request via letter issued on 4/9/26 as bellow:" …it's my understanding that the patient will begin to transition to hospice care imminently, and that the next of kin is planning to move R1 to a different care-home. I will therefore defer the determination of R1 bedbound vs non-ambulatory status until such time when I can solicit an unbiased opinion from the hospice team as it would be unreasonable at this time to force the patient to come into the office solely for this determination.

LPA interviewed RP via phone on 8/14/2026 and asked why RP thinks the 30 days relocation/eviction notice issued by facility on 3/25/2026 is unlawful? RP stated that I was in tough situation, facility was trying to kick R1 out after 14 years, they did not talk about eviction when I was at the facility on 3/18/2026. I did not know about this term (unlawful eviction), I called officer of day, explained the situation and they wrote this.
LPA asked if RP reviewed R1 Admission Agreement, RP stated I reviewed it after this happened, I didn't know about eviction procedure before because it was signed 14 years ago and we were in communication via phone call and text message.
4.Staff took resident off hospice without the consent of authorized representative
Per RP R1 was assigned Hospice care, as recommended need by caretaker and owner (AD), sometime in 2024 and released in September 2025 unbeknownst to me until last day of care. Reasons are still unclear.
AD stated during interview with LPA Jamaly that RP was definitely aware and in communication with the facility when R1 was recommended hospice and when discharged. Per AD, Blossom Ridge Hospice where R1 was residing can't release any document to AD because R1 already discharged.
AD submitted a written statement to the department, it reads" RP signed intake doc 1/13/2023 and discharge doc 9/8/25. R1 discharged from hospice care due to non-terminal illness/no longer need of hospice care.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20260327084535
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: D & C ELDERLY HOME
FACILITY NUMBER: 347005120
VISIT DATE: 08/28/2026
NARRATIVE
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page 5
On 8/14/2026 LPA Jamaly interviewed RP about this allegation and asked if this allegation, RP stated I still don't know why R1 was discharged from hospice on Sep 2025. RP in another statement mentioned that RP signed discharge paper and has been aware of all communication between hospice agency and facility about R1.
LPA reviewed Blossom Ridge Hospice Discharge Form dated 9/12/2025 and observed RP's handwritten signature and date. LPA also interviewed Executive Director of this hospice agency on 8/28/2026, Hospice ED confirmed that RP was aware of our communication and signed the discharge paper. Also, LPA observed RP's handwritten signature and date on Notice of Medicare Non-Coverage from dated 9/10/2025.

5.Staff did not allow authorized representative to use own hospice company for resident
Regarding this allegation, AD stated that RP was informed and actively involved in the hospice discussions.
LPA Jamaly observed text message from AD to RP sent on 3/13/26 at 1:43 PM, it reads " There is a change in R1 health, R1 seems weaker and refused to eat. I called the doctor and asked if R1 would be appropriate under hospice care. He thinks it is. What do you think? "RP Replied  on 3/16/26 at 11:19 AM " yes… please proceed as you deem appropriate… thank you so much AD for knowing to follow up- I appreciated you so much!"  LPA also observed text message RP sent to ED on 3/17/2026 at 3:32 PM, it reads" Whatever you want for my mom I support your decision".
LPA Jamaly interviewed RP on 8/14/2026 and asked if facility gave you a chance to choose your own hospice agency and if RP offered an alternative hospice agency. RP stated' I didn't have any alternative agency in mind at that time, but I was suspicious about the hospice agency that was offered by AD (Arias Hospice Care) because AD has called the R1 physician to approve R1 as bedridden in order to give them a chance putting R1 in their favorite hospice agency and I was notified by R1 physician about this conversation. Also, facility was using this hospice agency for their other facilities as well.
LPA also interviewed AD and asked if RP was given choice to use won hospice agency, AD stated yes, but RP did not give me own option, and I picked Arias Hospice agency because of providing high quality services and having good experience working with them.
Based on the interviews conducted, and records reviewed, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator, and a copy of this report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5