Complaint Investigation Report

347003494-10-14-2025-59-AS-TORZ-DN822J-20251107160045

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

09/19/2025 and conducted by Evaluator Cassie Yang

COMPLAINT CONTROL NUMBER: 59-AS-20250919154608

Resident developed several UTI's while in care due to staff neglect.

Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to deliver the finding of the allegation above. LPA met with Caregiver and explained the purpose of the visit.

For the allegation of, Resident developed several UTI's while in care due to staff neglect, based on an interview conducted with the Administrator, it was revealed that only one resident (R1) in care has had a recent urinary tract infection. The interview revealed that R1 was admitted to the facility with a catheter and has home health coming to the facility twice a week. The facility assists with catheter draining but is unable and not trained to clean the urinary tube. An interview conducted with the caregiver revealed that the caregiver assists with draining R1’s catheter bag as needed. R1 often tugs and pulls on the catheter, and once disconnected, then home health is contacted for the tube to be reinserted. Based on the information provided, the allegation is unsubstantiated.

As a result of this investigation, LPA finds the allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.

Exit interview and a copy of report was provided.