Complaint Investigation Report

315920037-2-18-2026-59-AS-MSEY-DRFTJD-20260219134611

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

02/12/2026 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20260212093422

Staff did not abide to the admission agreement

On 2/18/26, Licensing Program Analyst (LPA) Kevin Mknelly spoke with care giver S1 who notified Natalia Tulenenova. Natatia arrived for LPA to investigate and to deliver complaint findings for the above allegation.

LPA reviewed resident records and conducted interviews.

LPA finds that the allegations cited above are substantiated.

R1 was admitted to te facility while in hospice care on 11/22/25. R1 passed away on 11/25/25. R1's belongings were removed from the facility on 11/25/26 . To date, R1's representaives were not reimbursed for the balance for fees paid for Nov. 2024. Therefore R1's representative is owed a refund

As a result of this investigation, LPA finds allegation to be (S) Substantiated -

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