Complaint Investigation Report

317001644-1-14-2025-59-AS-KHOS-DD4LX2-20250120080801

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

12/13/2024 and conducted by Evaluator Graham Gunby

COMPLAINT CONTROL NUMBER: 59-AS-20241213093239

LPA Graham Gunby and LPMs Laura Munoz and Troy Ordonez conducted a complaint investigation to this facility to day. CCL staff me with Marcella Green and explained the purpose of today’s visit.

The department has learned that the facility has mold in multiple areas of the facility. A mold sample has been taken from this facility and identified the facility has elevated levels of fungal spores which have been noted as airborne, toxic and may cause serious health risk. In addition, during today’s visit, LPA and LPM observed debris in the yard of the facility as well as a glass paneling removed from the oven in the kitchen. Based on observations and documents reviewed, the licensee failed to ensure the facility is kept clean, safe and sanitary.

Due to the toxic airborne mold, the facility has failed to ensure resident’s personal rights are maintained as residents have a right to safe and helpful accommodations.

Based on information obtained during the investigation, the Department find the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies are cited on the attached LIC9099-D. Failure to correct deficiencies could result in civil penalties.