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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701433
Report Date: 05/21/2026
Date Signed: 05/26/2026 01:27:13 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
01/23/2026 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20260123122247
FACILITY NAME:SAFE HAVEN OAKDALE LLCFACILITY NUMBER:
502701433
ADMINISTRATOR:GRIMESEY, AILEEN POQUIZFACILITY TYPE:
740
ADDRESS:2912 WESTPORT CIRCLETELEPHONE:
(510) 224-6165
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:6CENSUS: 5DATE:
05/21/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Caregiver Emilie CarnicarTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility did not ensure staff assisted resident with ADLs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Caregiver Emilie Carnicar and explained the reason for the visit. LPA Lund spoke with Facility Manager Ryan Alejo who gave permission for Caregiver Emilie Carnicar to sign required paperwork. Census: 5

Facility did not ensure staff assisted resident with ADLs - Based on records reviewed, Oakdale Police report OP26-00201, interviews with staff, witnesses and residents in care. LPA Lund reviewed Appraisal/Needs and Service plan dated 11/15/2025 for resident (R1) which states R1 has a history intermittent episode of confusion, forgetfulness and difficulty managing day to day tasks. R1 has difficulty in Self-Care and Activities of Daily Living (ADLs). Interviewing witness stated that their residents in care were getting their ADLs met by staff and had no concerns.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
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 2
Control Number 27-AS-20260123122247
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: SAFE HAVEN OAKDALE LLC
FACILITY NUMBER: 502701433
VISIT DATE: 05/21/2026
NARRATIVE
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. Staff interviewed stated that R1 would refuse to take showers and didn’t have much clothing to meet her needs and would have to wash them constantly. Oakdale Police investigated (Neglect) based on statements provide and other residents stating they are taken care of, it was determined no crime had occurred at this time when reviewing report.

Based on records reviewed, Oakdale Police report OP26-00201, interviews with staff, witnesses and residents in care, and staff the information provided, it was unclear if facility did not ensure staff assisted resident with ADLs was deemed UNSUBSTANTIATED.

The Department (CCLD) has found the allegations. Unsubstantiated.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. Exit interview was conducted with and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
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