Complaint Investigation Report

347003611-9-26-2024-27-AS-KHOS-DA4Q2T-20241016114740

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

06/14/2023 and conducted by Evaluator Christina Valerio

COMPLAINT CONTROL NUMBER: 27-AS-20230614151545

Facility may not be financially solvent to continue operating.

A meeting was held on 9/25/24 at 2:00 PM regarding the findings of an audit report referencing the above mentioned allegation. Present in the meeting was Licensee Antonette Tin, Stephenie Doub, Regional Manager, Stephen Richardson, Licensing Program Manager, Czarrina Camilion-Lee, Licensing Program Manager, Licensing Program Analyst(s) Victoria Brown, Christina Valerio and Kevin Gould. Stephenie Doub stated the purpose of the meeting. Victoria Brown and Stephen Richardson reviewed the findings for the facility.

The Department has determined that a review of the records provided by the licensee and the confirmation by the RO that the facility has no residents in care. Therefore, the auditor has closed this audit request. Based on records review, the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, the preponderance of evidence standards has not been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited during this visit. An exit interview was conducted, a copy of this report was provided via email, and an electronic email read receipt confirms receiving these documents.