Complaint Investigation Report
342701176-7-21-2025-27-AS-KHOS-DK3MGP-20250730093617
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
SACRAMENTO SOUTH ASC , 9835 GOETHE ROAD, SUITE 100
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/18/2025 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20250718142715
Staff member shared client's confidential information
On 07/21/2025, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility unannounced regarding a complaint. LPA Campbell met with Administrator Fuentes and explained the purpose of the visit.
Regarding the allegation that a staff member shared client's confidential information, another facility notified the Department they had received confidential documents from Cisters Loving Care Hiome II . The Department then received images of these documents. The documents included MARS (Medication Administrator Records) for Resident 1 and Resident 2 (R1 and R2) When interviewed, Staff 1 (S1) confirmed they had provided MARs documents from Cister's Loving Care Home II to show another facility how Cister's II records medication information.
Based on LPA’s interviews conducted and documents reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiency is being cited on the attached 809-D during this visit. An exit interview was conducted, and copies of the report and appeal rights left.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction