Complaint Investigation Report

312700574-7-10-2025-59-AS-MSEY-DJUL57-20250723082637

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

07/09/2025 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20250709102716

-Staff does not have criminal background clearance

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Executive Director (ED), Keith Payne, and the Assistant Executive Director, Amanda Farley, to open a complaint investigation and deliver complaint investigation findings regarding the above stated allegation.

During today's visit, LPA conducted interviews and obtained documentation pertinent to the investigation. Interview with ED indicated that staff (S1) is employed in the independent living section of the facility as a transportation driver. S1 provides transportation periodically for residents in the assisted living and memory care sections of the facility. S1 does not have fingerprint clearance or exemption and is not associated to the facility.

Based on interviews conducted, the preponderance of evidence standards have 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. Exit interview conducted. A copy of this report and appeal rights were provided.