Complaint Investigation Report

345002876-4-11-2024-59-AS-KHOS-D4LHEM-20240423060806

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

04/05/2024 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20240405111746

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Facility Owner, Mark Graham, to open a complaint into the allegation listed above.

During today's visit, LPA interviewed Facility Owner. Facility Owner stated that resident (R1) was a prospective resident, that they chose not to move into the facility after paying a preadmission fee, and a written disclousure regarding refunds for preadmission fees was not given to R1's respresentative.

Based on interviews conducted, 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 Facility Owner. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.