342701508-5-22-2026-27-AS-LRIS-DUNSAZ-20260602134311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701508
Report Date: 05/22/2026
Date Signed: 05/22/2026 11:37:27 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
03/09/2026 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20260309153949

FACILITY NAME:	SENIOR GUEST HOME		FACILITY NUMBER:	342701508
ADMINISTRATOR:	BULOU DRANICA MATAMADUA		FACILITY TYPE:	740
ADDRESS:	8890 HARLOW CT		TELEPHONE:	(702) 629-0201
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 4	DATE:	05/22/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Apakuki Nawasa, Facility Manager		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not prevent residents from engaging in a physical altercation.

INVESTIGATION FINDINGS:

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On May 22, 2026, Licensing Program Analyst (LPA) Arvin Villnueva arrived unannounced to this facility to conduct a follow-up complaint visit and deliver findings of the above allegation. LPA Villanueva intially met with staff on duty, Elgeata Crooks (S1) and stated the purpose of the visit. Present during this visit were 4 residents with 2 staff on duty.

Upon arrival, LPA was greeted by S1 and stated she is helping today and that two residents were out for a walk with Apakuki Nawasa (S2). S2 arrived shortly after with two residents from their walks. S2 confirmed he is still the facility manager.

It was alleged that staff did not prevent residents from engaging in a physical altercation. The investigation into this allegation consisted of interviews and record reviews.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

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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Control Number 27-AS-20260309153949

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: SENIOR GUEST HOME	FACILITY NUMBER: 342701508
	VISIT DATE: 05/22/2026

NARRATIVE

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Based on interviews conducted with three staff members, all denied that any residents had been involved in a physical altercation. Staff reported that one resident has a history of alleging that they were hit or involved in fights with others in the home. Interviews were also conducted with five residents, all of whom denied being involved in any physical altercation with other residents. Additionally, all five residents denied witnessing any physical altercations involving other residents.

A review of R1’s pre-appraisal, daily notes, and Needs and Services Plan indicates that R1 has a history of reporting injuries allegedly caused by others in the home. Due to the conflicting information obtained, it could not be determined whether staff failed to prevent residents from engaging in a physical altercation.

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 with S2 and a copy of this report and appeal rights were provided to the facility at the end of this visit.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026

LIC9099 (FAS) - (06/04)

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