Complaint Investigation Report

315002920-4-16-2025-59-AS-LMUZ-DG6UYB-20250428155940

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

03/03/2025 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20250303120651

Resident sustained bruises while in care.

On April 16, 2025, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Caregiver Iwan Wibono.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows:

Resident sustained bruises while in care.

Resident in question moved out of the facility in September 2024 and the department was unable to obtain information regarding the allegation above. Saff and residents interviewed were unable to recall or provide information regarding the allegation above; therefore, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted and copy of the report was provided.