Complaint Investigation Report

345003014-1-25-2024-59-AS-MSEY-CZXM5M-20240129081830

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

01/22/2024 and conducted by Evaluator Angela Hood

COMPLAINT CONTROL NUMBER: 59-AS-20240122135356

-Facility is not providing medications as prescribed

-Facility is not keeping medications locked away

Licensing Program Analyst (LPA) Angela Hood arrived unannounced at the care home today, 1/25/24, and met with Administrator, Persida Pop, to open and deliver findings into a complaint investigation regarding the above stated allegations.

During today's visit, LPA observed the keys to the medication cart hanging from the cart. LPA attempted to conduct a medication count. However, the facility does not have documentation for when each medication bottle was started and a medication count could not be conducted.

Based on observation and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page.

Exit interview conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.