Complaint Investigation Report

092700093-10-30-2023-59-AS-LMUZ-CXCTQ8-20231107135531

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

09/19/2023 and conducted by Evaluator Lavinia Muscan

COMPLAINT CONTROL NUMBER: 59-AS-20230919083923

Facility staff are sleeping in resident's bedroom

On 10/30/23, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Motu Sokimi. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.The results of the investigation are as follows:

Facility staff are sleeping in resident's bedroom. - SUBSTANTIATED

Department conducted interviews, records were reviewed and facility observation to investigate this complaint allegation. As a result of the investigation: department finds that a former staff member did sleep in a resident's room. That staff member quit their position since the incident happened. As a result of this investigation, department finds the allegation(s) to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation(s) s valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6.

Exit interview with administrator. Appeals rights provided. Copy of the report provided to facility.