Complaint Investigation Report

097005046-12-8-2025-59-AS-LMUZ-DPHSRV-20251219130659

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

11/13/2025 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20251113150027

Licensee did not ensure staff met criminal record clearance requirements prior to working at the facility.

On December 8, 2025, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegation listed above and met with Administrator Melisa Tiburcio. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Based on documents obtained facility did not ensure that a criminal record clearance was obtained for S1 in 2022, when S1 was working at the facility. Record review indicated that S1 started working on April 13, 2022, and did not get the fingerprint clearance until February 2, 2023, which poses an immediate health, safety, or personal rights risk to persons in care. The preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Immediate civil penalty of $500.00 was issued today. Failure to correct shall result in civil penalties.

Appeal Rights given to administrator. A copy of this report has been provided to facility. Exit interview conducted.