Complaint Investigation Report

057005020-5-1-2024-27-AS-KHOS-D5XKTQ-20240605081130

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

03/04/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20240304114818

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.

On 03/25/24 and 05/01/24 LPA Lewis visited the facility and conducted interviews with staff, interviews with residents and documentation reviews that included chart notes and medical files. According to medical file reviews, chart note reviews and physician order reports, as well as R1. R1 was not admitted into the hospital and interview with S1 they state they left the hospital at 3:00 AM.

Based on interviews and record reviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview and copie of report and appeal rights given.