Complaint Investigation Report

315920101-7-8-2026-59-AS-LMUZ-DVXQ6Q-20260713115354

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

06/29/2026 and conducted by Evaluator Melissa Parks

COMPLAINT CONTROL NUMBER: 59-AS-20260629084943

Facility staff did not provide adequate supervision, resulting in a resident eloping from the facility

Licensing Program Analyst (LPA) Melissa Parks arrived on Wednesday July 8, 2026 unannounced to conduct a complaint visit regarding the above allegation. LPA met with Administrator Maria and explained the purpose of the visit.

LPA interviewed the Administrator regarding the allegation. LPA learned the following: On 6/28/2026 at approximately 1 am, R1 exited from the front door of the facility and proceeded to walk down the road. R1 was returned to the facility by a neighbor who was returning home. LPA learned that the front door alarm did not alert staff that it was opened. R1 is diagnosed with Dementia with no history of wandering.

Based on the information detailed above, LPA finds the allegation to be substantiated. A finding that the allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on 9099-D. Exit interview conducted. A copy of this report and appeal rights were provided.