Complaint Investigation Report

345920078-5-6-2025-59-AS-LMUZ-DGLULL-20250512154056

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

04/30/2025 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20250430114336

Staff does not ensure facility is free of mold.

On 05/06/25, Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced and met with Business Office Director, Jessica Brass to do complaint investigation into allegations listed above. LPA explained the purpose of the visit upon arrival.

LPA investigated allegation, “Staff does not ensure facility is free of mold. ” LPA interviewed resident ,R1 in which they stated that there was mold in their shower as R1 saw black stuff coming from bathtub during showers. LPA interviewed maintenance staff ,S1, in which he stated that he was not aware about mold in R1s bathroom but saw small crack in shower tub and filled it while LPA and R1 were present. R1 was satisfied with the fixture and will inform maintenance team know if any other issues arises with this matter. LPA toured the facility and did not observe mold in the facility. Due to the conflicting information, LPA finds allegation to be UNSUBSTANTIATED.

A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit meeting conducted. A copy of this report has been provided to facility.