Complaint Investigation Report

345003010-1-2-2025-59-AS-KHOS-DCNS9E-20250106124038

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

12/31/2024 and conducted by Evaluator Sabrina Calzada

COMPLAINT CONTROL NUMBER: 59-AS-20241231115538

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to open and close a complaint received on 12/31/24. LPA met with Dan Mititi, Administator, and explained the reason for the inspection. Also present was staff (S1) who on duty. Currently there are (3) residents on hospice. LPA and Administrator toured the interior to observe residents in care. There were no concerns noted.

LPA and Administrator discussed the allegation staff (S2) not being cleared before starting to work at the facility. Documentation showed staff (S1) was cleared and associated to the facility on 6/16/23; (S2) was cleared and associated to the facility on 6/16/23 and worked unitl on/around 7/8/24 and was disassociated. (S3) was cleared and associated on 8/12/23. Review of the LIC500 and Guardian show all current staff are cleared and associated currently to the care home. Administrator confirmed all of this information in today's inspection.

Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without reasonable basis. This allegation is being dismissed without further investigation. Exit interview. Copy of report provided.