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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005649
Report Date: 09/01/2026
Date Signed: 09/01/2026 09:36:44 AM

Unfounded


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
08/24/2026 and conducted by Evaluator Sulma Lopez
COMPLAINT CONTROL NUMBER: 27-AS-20260824121152
FACILITY NAME:STA. RITA'S ELDER CAREFACILITY NUMBER:
347005649
ADMINISTRATOR:FLOWERS, RITA C.FACILITY TYPE:
740
ADDRESS:8982 MERLOT WAYTELEPHONE:
(916) 689-5828
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY:5CENSUS: 4DATE:
09/01/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Evangeline UjanoTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not refill residents medications timely resulting in missed medications
Staff did not provided authorized representative complete resident record upon discharge
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On August 27, 2026, at 9:30 AM, Licensing Program Analyst (LPA) Sulma Lopez arrived unannounced at the facility to conduct a complaint investigation on the above allegation(s). LPA Lopez met with Administrator Evangeline Ujano and explained the purpose of the visit. The current census is (4) residents.

Throughout the course of the investigation, LPA Lopez conducted interviews, record reviews, and a facility inspection. Medication administration records were reviewed and observed to be complete and properly maintained. During the visit, it was learned that the resident on the complaint report did not reside at this facility.
As a result of the investigation, the Department finds this allegation to be Unfounded. A finding that the complaint is unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis. Per California Code of Regulations (CCR) - Title 22, no deficiencies were cited during this visit.
An exit interview was conducted with, and a copy of this report was provided to the facility.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Sulma Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
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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