Complaint Investigation Report

315920037-7-8-2025-59-AS-MSEY-DK2P8R-20250729110556

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

05/19/2025 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20250519143314

Facility failed to contact resident's conservator that resident was taken to the hospital.

On 7/8/25, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Natalia Tuleninova, Administrator, to deliver complaint findings for the above allegation.

LPA reviewed resident records, facility records and conducted interviews.

LPA finds that the allegations cited above are substantiated.

Documents and conservator's office statement showed that Admin failed to notify the conservator's office as required for R1's hospitalization.

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 Admin . Copy of this report and appeal rights provided.