Complaint Investigation Report

317001368-11-4-2024-59-AS-KHOS-DBCLZ2-20241125081112

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

04/11/2024 and conducted by Evaluator Todd Tryon

COMPLAINT CONTROL NUMBER: 59-AS-20240411150538

Facility staff did not properly supervise resident as stated in the individual program plan

On 11/4/2024 LPA Tryon visited the facility to complete the complaint. LPA met with Lisa Varela. LPA spoke with Administrator Chris Chu by telephone; he agreed to have staff LIsa sign the report.

During the course of the investigation LPA has reviewed facility records, Admission Agreement, IPP, Conservatorship documents, interviewed residents and staff, reviewed law enforcement report.

Regarding the allegation that facility staff did not properly supervise resident as stated in the individual program plan, LPA reviewed IPP, conservatorship document, interview resident and staff. LPA learned that the Licensee did drop R1 and another resident at a church on 3/17/2024 to attend a Bible study group. LIcensee left the church, and left residents to the supervision of the person heading the group. R1 had alleged that another male client from another facility had touched her private area. Police report found that investigating officer did not believe probable cause existed for any crime. However, at this time, it appears that the facility did not follow the IPP that states resident "must have supervision 100% of the time by staff from her care home." Therefore, the allegation is found to be substantiated. A finding of substantiated means that the allegation is valid because a preponderance of the evidence standard has been met.