Complaint Investigation Report
347003297-6-25-2025-59-AS-KHOS-DJ5QSF-20250630122528
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
06/20/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250620094344
Facility staff mismanaged resident's medications
On June 25, 2025 (6/25/24), Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility and met with Licensee, Aida Briones, to open an investigation into the complaint allegation listed above.
During the investigation, the Department reviewed documentation pertinent to the investigation (CSMR and MARs) and received statements from additional parties involved in the R1’s care services.
The results of the investigation are as follows: LPA Michael Hood received Centrally Stored Medication Form (CSMF) and Mediation Administration Record (MAR) for resident (R1). LPA reviewed R1’s CSMF and MAR and observed discrepancies between records for at least five (5) of R1’s medications.
LPAs also reviewed a statement from hospice stating R1’s medications have not been managed and administered as ordered.
Based on 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. A copy of this report and appeal rights were provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction