Complaint Investigation Report

315001968-7-8-2024-59-AS-MSEY-D72LT3-20240710090138

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

07/03/2024 and conducted by Evaluator Melissa Parks

COMPLAINT CONTROL NUMBER: 59-AS-20240703095747

LPA Parks arrived on Monday July 8, 2024 to open a complaint investigation regarding the above allegation.

LPA discussed the allegation with Administrator Laurie. LPA discussed the allegation with R1. LPA reviewed R1's file and obtained the following copies: care plan, emergency and ID form, Advanced directive, and admission agreement. Additionally, LPA interviewed R1's family and staff regarding the allegation. Based on interviews, LPA determined that R1 was able to vocalize if they wanted to see certain visitors. The facilty would then honor R1's decision.

Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted. A copy of this report was left at the facility.