347005649-9-1-2026-27-AS-APAA-DY7MVZ-20260923095732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005649
Report Date: 08/27/2026
Date Signed: 09/01/2026 09:33:25 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

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260824121152

FACILITY NAME:	STA. RITA'S ELDER CARE		FACILITY NUMBER:	347005649
ADMINISTRATOR:	FLOWERS, RITA C.		FACILITY TYPE:	740
ADDRESS:	8982 MERLOT WAY		TELEPHONE:	(916) 689-5828
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY:	5	CENSUS: 4	DATE:	08/27/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator- Evangeling Ujano		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

(13) Medication
(8) Record Keeping

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

This LIC 9099 report has been amended to reflect the above allegations. A new LIC 9099 will be created, which will supersede this report.
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: 08/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2026

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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