Complaint Investigation Report

057005020-5-1-2024-27-AS-KHOS-D64HBK-20240610060313

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO SOUTH ASC , 9835 GOETHE ROAD, SUITE 100

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

03/18/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20240318153415

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver complaint investigation findings. LPA explained the purpose of the visit and was met by staff.

The investigation was conducted by LPA Lewis. The investigation consisted of LPA facility observations, interviews with staff, interviews with residents and review of resident files, resident medical files, and chart notes. On 3/13/2024, 03/25/2024 and 05/01/2024 LPA Lewis visited the facility and conducted interviews with staff, interviews with residents and documentation reviews. Based on LPAs observations and interviews which were conducted S1-S4 accounts of the facility were consistant and R2 and not experinedced or seen any consurns. The preponderance of evidence standard has not been met, therefore, the Department has determined the the alleagations to be 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 and a copy of the report given.