Complaint Investigation Report

045002775-10-22-2025-59-AS-LCRR-DMWPLE-20251029112438

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

10/21/2025 and conducted by Evaluator Kayla Adkison

COMPLAINT CONTROL NUMBER: 59-AS-20251021112112

On October 21, 2025, Licensing Program Analyst (LPA) Kayla Adkison arrived at the facility unannounced for the purpose of opening a complaint investigation. LPA was greeted by Bailey Malagon, Administrator, and explained the purpose of the visit. During the visit, there were 23 residents in care and 3 direct care staff. LPA and Administrator toured the facility and made observations.

Allegation: Facilty signal system is inoperable

It was alleged that the facility's emergency pull cords from resident's rooms were inoperable. Staff informed LPA that the pagers for the call system were all missing or inoperable. During the inspection, LPA observed Administrator pull (1) one emergency alert cord from a resident room. Administrator showed LPA that the alert then shows up on a computer in the facilities charting room. LPA noted there were no sounds observed. (2) two of (2) two residents interviewed stated that when they were in need of assistance it took over an hour for staff to come too their need. Administrator stated that once it was known that the pagers were all missing or inoperable, a staff member was temporarily assigned to sit in the charting room to monitor the computer were alerts are recorded. Administrator noted that (5) five new pagers have been ordered and are scheduled to be delivered to the facility on October 23, 2025.

Based on observation and interview, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22), is cited on the attached LIC 9099D. Exit Interview conducted. A copy of this report and Appeal Rights were provided to Bailey Malagon, Administrator.