Complaint Investigation Report

342700722-7-28-2025-27-AS-LRIS-DKAM4N-20250806091701

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

05/15/2025 and conducted by Evaluator Arielle Pascua

COMPLAINT CONTROL NUMBER: 27-AS-20250515162057

Resident was injured by motorized cart while in care.

On 07/28/2025, Licensing Program Analysts (LPAs) Arielle Pascua and Arvin Villanueva arrived unnanounced to this facility to conduct a complaint visit. LPAs met with Facility Designated Administrator (FDA), Elena Cuevas and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Current Census was 108. A brief interview with FDA Cuevas was conducted.

It was alleged that the resident was injured by the motorized cart while in care. During the course of this investigation, it was denied by the resident that they were injured by a motorized cart that was driven by another resident. It was stated that the resident would often drive fast, however was never hurt at the time. Based on the information gathered, there is not sufficient evidence to prove that the resident was injured by the motorized cart while in care. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time.

An exit interview was conducted and a copy of this report were provided to the facility at the end of this visit.