Complaint Investigation Report

315002954-1-28-2026-59-AS-TORZ-DR6RGW-20260210120124

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 2525 NATOMAS PARK DR STE 270

This is an official report of an unannounced visit/investigation of a complaint received in our office on

01/14/2026 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20260114162229

Staff did not report incidents to resident's responsible party.

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with James Dial during today’s inspection.

LPA investigated allegation, “Staff did not report incidents to resident's responsible party.” LPA interviewed relevant party in which they stated R1 had a fall in the dining room in December 2025 and the incident was not reported to the responsible party. LPA interviewed Administrator in which he stated he recalled the incident however no documentation was taken and it appears staff did not notify the responsible party or CCL of the fall incident. Due to the information gathered LPA finds allegation to be SUBSTANTIATED.

As a result of this investigation, LPA finds allegations 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. Deficiencies cited on 9099-D. Copy of report provided to the facility.