Complaint Investigation Report

045000644-12-7-2023-59-AS-KHOS-CZ7LN6-20240105075345

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/06/2023 and conducted by Evaluator Jaynae Boyles

COMPLAINT CONTROL NUMBER: 59-AS-20231106081750

Licensee does not ensure call signal system is in good repair.

Staff do not ensure residents care needs are being met in a timely manner.

12/07/2023 Licensing Program Analyst (LPA) Jaynae Boyles made an unannounced visit to the facility and met with Executive Director Scott Blow. The purpose of this visit is to deliver the results of a complaint investigation.

During the interview process, the executive director and three residents were interviewed.

During the investigation, it was reported by the Administrator and residents that the signal system was in working order. It was discovered that not all residents were given a pendent. However, all residents have access to a signal system within their unit. There are two wall mounted signal mechanisms that can be taken off the wall to become mobile. All residents have access to a signal system.

This agency has investigated the complaint alleging the facility signal system is in disrepair and not meeting the needs of the residents. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted. A copy of the report was provided to the executive director, Scott Blow.