Complaint Investigation Report

347005010-4-15-2026-59-AS-LMUZ-DTCVCJ-20260421161913

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

03/30/2026 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20260330120415

Staff did not ensure they were not over capacity.

Staff are operating outside the scope of their license.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 4/15/26 to deliver complaint findings for above allegations. LPA met with Staff, Alma Peregrino and explained the purpose of the visit.

The department conducted records review ,facility observations and interviews to investigate the complaint. Residents interviews indicated that their care needs were met and there were no complaints. Staff interviews reflected that facility was Not over capacity and operating within their scope of practice and there were no wrongdoings in this context. During department's visits on 4/2/26 and 4/15/26 , department observed no concerns in this area. From the gathered information, It was evaluated that facility was operating within their scope of practice with directed guidelines and following Title 22 regulations with facility's operations and there were no issues to address. Based on gathered information, these allegations were UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted and a copy of this report was provided. Signature on these forms acknowledges receipt of these documents.