Complaint Investigation Report

342700761-7-23-2024-59-AS-TORZ-D7P2LD-20240730172920

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

07/18/2024 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 59-AS-20240718091516

On 7/23/24, Licensing Program Analyst (LPA) Kevin Mknelly spoke with Maria Cucicea by phone to open the complaint and to deliver complaint findings for the above allegation.

LPA reviewed resident records and conducted and interview . LPA finds that the allegations cited above are substantiated. R1 movied into the facility on 5/7/23 and the contract was terminated on 5/23/24. LPA and Maria discussed fees charged and fees to be refunded. It was found that, through human error, the refund, paid today, exceeded the 15 days from the time of move out.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

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