Complaint Investigation Report

317005513-12-7-2023-59-AS-KHOS-CYERQG-20231211121330

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

11/27/2023 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 59-AS-20231127153107

Facility did not refund resident's responsible party.

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

LPA reviewed R1 admission agreement, billing statements, and other documentation. Admission agreement indicates after the death of a resident within fifteen days after property is removed from apartment, estate, or other person or entity will receive a refund of any fees paid in advance. LPA was able to determine R1 passed in October 2023 and a refund was not issued until December 2023. In addition, Health and Safety Code §1569.652 states facilities are required to refund responsible party within 15 days of the death of a resident and once their personal belongings have been removed. Due to the information gathered, LPA finds allegation to be SUBSTANTIATED. Deficiencies cited on 9099-D. Exit interview conducted and appeal rights provided.