Complaint Investigation Report

345920120-10-15-2025-59-AS-MSEY-DMPS48-20251022133219

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

09/24/2025 and conducted by Evaluator Melissa Parks

COMPLAINT CONTROL NUMBER: 59-AS-20250924093636

Facility is not following the admission agreement

Licensing Program Analyst (LPA) Melissa Parks arrived unannounced on Wednesday October 15, 2025, to deliver findings for a complaint regarding the above allegation. LPA met with Administrator Navgeet and explained the purpose of the visit.

Throughout the course of the investigation, LPA interviewed staff regarding the allegation. LPA reviewed the Assisted Living Waiver Provider handbook, R1’s LIC602 and care plan. LPA learned that R1 is on the Assisted Living Waiver program. As part of R1’s activities of daily living, they require assistance with incontinence care. While the incontinence products are provided through R1’s insurance, the facility provides gloves and wipes. Previously, the Administrator picked up R1’s medications from the pharmacy and asked for reimbursement for R1’s copay. R1 has a payee which handles all of R1's finances.

Based on information obtained during the investigation, LPA finds the allegation to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Exit interview. A copy of this report was emailed to the Administrator.