Complaint Investigation Report

340317173-10-9-2024-27-AS-KHOS-DA4VFX-20241016162440

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO SOUTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

09/25/2024 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20240925091428

Physical Plant: Staff did not ensure facility was free from pests.

This is an amended report to accurately reflect the complaint is unsubstantiated. Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection to Dosty's Private Incare Service II ARF on DATE9/27/24 at 11:15am to inform the licensee of complaint allegation mentioned above.

During this investigation LPA Gould interviewed S1, S2, and R1 (See confidential name list LIC-811 dated (9/27/24). LPA conducted a walkthrough of the facility, observed new matresses on resident beds, food supplies met regulations. LPA obtained records for three pest control inspections dated 8/15/24, 8/22/24, 8/27/24 and 9/6/24. All documented pest control inspections did not identify any observable pests during any previous inspections. Pest control provided treatment at each inspection. all staff and resident interviewed denied the allegations.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Physical Plant are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.