Complaint Investigation Report

347005580-3-17-2023-59-AS-KHOS-CQDK3E-20230329073238

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

03/08/2023 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20230308110622

Resident caused injuries to another resident in care.

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced on 3/17/2023 to open and deliver the findings of a complaint the Department received regarding the allegation cited above. LPA met with Administrator, Darrell Price and explained the purpose of the visit. LPA wore the following Personal Protective Equipment: surgical mask. Additionally, LPA was screened and tested at entrance by staff.

During today's visit, Administrator informed LPA the incident occurred at skilling nursing facility, not in the assist living unit. LPA informed Administartor CCLD does not regulate skilled nursing, it will be public health. Administrator stated public health was informed of the incident and has came out retrieve documents.

Based on the interview conducted, LPA found the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit Interview conducted and a copy of the report was left at the facility.