Complaint Investigation Report

342700185-3-27-2026-27-AS-LKIG-DV3LJ6-20260615084724

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

01/29/2026 and conducted by Evaluator Noel Wolf Petersen

COMPLAINT CONTROL NUMBER: 27-AS-20260129115313

Licensing Program Analyst, LPA Wolf Petersen, arrived unannounced at 4:00pm with an Alta Regional Service Cooridnator, ARSC, Mai Thor to conduct a complaint investigation into the above allegation. The LPA met with administrator Monica Butay and Licensee Raul Cupino to explain the purpose of the visit.

LPA interviewed 2 staff, while ARSC interviewed 4 residents. R1 made a statement that S1 physically abused her by dragging her by her hair, it was learned in interview that R3 provided a similar statement about a seperate incident where S1 was grapping R3's hair and chin. S4 provided a statement that S1 threatened to damage her property but neither made a threat against her person or carried out any property damage. Staff/Licensee of the facility provided a statement that they did not find it likely that S1 physically abused a resident, and S1 had decided to quit the facility. S1 denies the allegation.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D. A copy of the report was read and given to the administrator, appeal rights provided. exit interview conducted.