Complaint Investigation Report

315002955-6-29-2023-59-AS-KHOS-CTDLBH-20230703083645

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

06/06/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20230606153419

Facility did not provide requested records to resident's responsible party.

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with Administrator Antonette Edwards during today's inspection.

During complaint investigation LPA interviewed administrator and relevant party. Relevant party stated on May 10th 2023, they faxed in a request for documents for R1. Documents were not released to requesting party until June 22nd 2023. Administrator stated R1's documents were in the storage area and it took time to find the requested documents. Although the documents have been released, at the time of the complaint documents had not been released. Due to this information LPA finds allegation to be UNSUBSTANTIATED.