Complaint Investigation Report

342701084-5-2-2024-27-AS-SRIN-D5WMM4-20240604094317

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

04/22/2024 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20240422144541

Facility staff served expired foods to residents

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegations on 5/2/24 at 7:30a. LPA met with Emily Pascua and stated the purpose of the visit. On 5/1/24, LPA toured the facility, interviewed resident #1 (R1) - (R4), Administrator and Caregiver Randmelvin L Pozon. LPA requested a list of staff with contact information, food receipts, facility utility bills, and resident roster. Based on a subsequent visit today,"Facility staff served expired foods to residents", LPA observed opened freezer burned food items in the freezer in the garage that was not labeled or dated. Licensee stated that those will be thrown away today. The above allegation is SUBSTANTIATED. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are cited on the 9099D during this visit. Licensee was provided a copy of their rights (LIC9058) and their signature acknowledges receipt of these rights. Exit interview held, a copy of report was provided.