Complaint Investigation Report

315920051-4-9-2025-59-AS-MSEY-DFRM87-20250415092238

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

01/09/2025 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20250109141346

Staff did not ensure reporting requirements were followed

On April 9, 2025, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Executive Director/ Administrator, Michael Clymo, to deliver complaint findings for the above allegation.

LPA reviewed resident records, facility records and conducted extensive interviews.

LPA finds that the allegations cited above are substantiated.

Interviews of facility staff found that when a infectious illness was discoverd at the facility and email was sent out to families. Due to a administrative error, family of R1 was left off the email list and not notified. This lead to exposure of family.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed with executive director . Copy of this report and appeal rights provided.