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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700194
Report Date: 06/18/2026
Date Signed: 06/18/2026 09:45:16 AM

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
03/17/2026 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260317161456
FACILITY NAME:NORRIS SENIOR HOMEFACILITY NUMBER:
342700194
ADMINISTRATOR:VERA, NAZARINA DEFACILITY TYPE:
740
ADDRESS:4184 ENGLE ROADTELEPHONE:
(916) 571-5650
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:6CENSUS: 5DATE:
06/18/2026
UNANNOUNCEDTIME BEGAN:
07:34 AM
MET WITH:Rosana GeronimoTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff neglect led to a resident developing pressure injuries while in care.
Staff left a resident in a soiled diaper for a long period of time.
Staff did not respond to a resident's call button.
Staff are not bathing a resident in care.
Staff did not serve an adequate amount of food portions to a resident in care.
INVESTIGATION FINDINGS:
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On 06/17/2026, Licensing Program Analysts (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPAs met with Facility Staff, Rosana Geronimo and explained the purpose of the visit. LPA Pascua asked for Staff Geronimo to call the Facility Designated Administrator (FDA), Nazarina Vega to inform them that CCL was present. Shortly after, FDA Vega he purpose of the visit was to deliver complaint findings for the allegations above.

Current census was 5. A brief interview with Staff Geronimo was conducted.
Allegation: Staff neglect led to resident developing pressure injuries while in care.
It was alleged that staff neglect let to resident developing pressure injuries while in care. During the course of this investigation the department conducted interviews and reviewed facility records. Based on interviews conducted, it was determined that a resident was observed to have a pressure injury upon admission in or around January 2026.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026
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 3
Control Number 27-AS-20260317161456
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: NORRIS SENIOR HOME
FACILITY NUMBER: 342700194
VISIT DATE: 06/18/2026
NARRATIVE
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Facility staff notified the home health agency and coordinated with the Home Health Nurse to assist with the treatment and management of the pressure injury while the resident remained in care at the facility.A review of facility records indicated that the resident was provided with a pressure-relieving mattress through home health services to help prevent further skin breakdown and reduce the risk of future pressure injuries. Documentation further showed that the pressure injury was subsequently assessed and determined to be healed by a licensed healthcare professional.Based on the information gathered, there is not sufficient evidence to show that staff neglected the resident which lead to pressure injuries.

Allegation: Staff left a resident in a soiled diaper for a long period of time.

It was alleged that staff left a resident in a soiled diaper for a longer period of time. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted with five residents, one out of five residents stated that facility staff had left them in a soiled brief for an extended period of time. The remaining four out of five residents stated that facility staff did not leave them in a soiled brief. Interviews were also conducted with four staff members. All four staff members denied leaving residents in a soiled brief for an extended period of time. A review of facility records revealed that one of the five residents consistently declined incontinence care, stating that they were "dry" and did not require changing at the time of staff intervention. Documentation further indicated that facility staff provided ongoing reminders and education to the resident regarding the importance of routine changes and incontinence care.Based on the information gathered, there are inconsistent statements that indicate that the staff left the resident in a soiled diaper for a long period of time.

Allegation: Staff do not respond to a resident’s call button.

It was alleged that staff do not respond to a resident’s call button. During the course of this investigation, interviews with 5 residents and 4 staff members were conducted. 1 out 5 residents state that the facility staff do not respond to the resident’s call button. 4 out 5 residents deny that the facility staff do not respond to their call buttons. 4 out 5 residents state that they are able to obtain help from the facility staff within 5-10 minutes. Interviews with 4 staff members were conducted. 4 out 4 staff members deny that they do not respond to a resident’s call button. Based on the information gathered, there is not sufficient evidence to prove that staff do not respond to a resident’s call button.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260317161456
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: NORRIS SENIOR HOME
FACILITY NUMBER: 342700194
VISIT DATE: 06/18/2026
NARRATIVE
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Allegation: Staff are not bathing a resident in care.

It was alleged that staff are not bathing a resident in care. During the course of this investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted with five residents, one out of five residents stated that facility staff do not respond to their call button in a timely manner. The remaining four out of five residents denied experiencing issues with staff responding to their call buttons. Four out of five residents further stated that they are typically able to obtain assistance from facility staff within approximately 5 to 10 minutes of activating their call button. Interviews were also conducted with four staff members. All four staff members denied failing to respond to resident call buttons and stated that resident requests for assistance are addressed as promptly as possible. Based on the information gathered, there are inconsistent statements that indicate that the staff are not bathing a resident in care.

Allegation: Staff did not serve an adequate amount of food portions to a resident in care.

It was alleged that the facility staff did not serve an adequate amount of food portion to a resident in care. During the course of the investigation, the department conducted interviews and reviewed facility records. Based on interviews conducted with five residents, one out of five residents expressed dissatisfaction with the facility's food service. The remaining four out of five residents stated that they had no concerns regarding food quality, portion sizes, or meal service. Interviews were also conducted with four staff members. All four staff members denied failing to provide residents with adequate food portions and stated that meals are served in accordance with residents' dietary needs and facility standards. A review of facility records indicated that the residents interviewed had not documented any concerns regarding food portions, meal quality, or food service at the time of review. Based on the information gathered, there is not sufficient amount of evidence to prove that the facility staff did not serve an adequate amount of food portions to a resident in care.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3