Complaint Investigation Report

312701038-9-13-2023-59-AS-KHOS-CW8RQA-20231002131313

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

07/20/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20230720161339

Staff did not provide a proper written notice of resident's rate increase to Resident's Representative.

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue investigation into allegations listed above. LPA met with Administrator Marina Iancu during today's inspection.

LPA investigated allegation listed above. LPA conducted interviews and conducted a file review. LPA obtained a copy of letter of rate increase provided to R1's representative. R1 required a higher level of care and administrator provided a letter which explained the new care that was required for R1. The letter did not provide a itemization of the charges. Due to the information gathered, LPA finds allegation to be SUBSTANTIATED.

Exit interview and appeal rights provided.