Complaint Investigation Report

345002989-5-20-2024-59-AS-APEZ-D6YU58-20240708151617

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

05/17/2024 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20240517152244

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Alex Novell, to open a complaint into the allegation listed above. During today's visit, LPA interviewed Licensee and Administrator, China Washington, and reviewed documentation pertinent to the investigation. LPA reviewed a text authored by Licensee and issued to resident (R1's) responsible party (RP) stating regarding to the text to "consider it as a 30 day notice to take [R1] somewhere else." LPA observed a text authored by Administrator and sent to R1's RP stating to "disregard the 30 day notice."

Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.