Complaint Investigation Report

342700594-1-17-2025-27-AS-KHOS-DEQKEA-20250313075001

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

10/21/2024 and conducted by Evaluator Holly Williams

COMPLAINT CONTROL NUMBER: 27-AS-20241021094841

Administrator is not permitting resident's authorized representative to participate in decisions regarding resident's care

Licensing Program Analysts (LPA) Holly Williams made an unannounced visit to conclude the investigation of the above allegations and to deliver the findings. LPA Williams met with facility administrator Martin Nichols and together discussed the investigation details.

This investigation consisted of interviews, observations, and record review. LPA Williams interviewed two staff members (S1-S2), Caregiver, and one resident (R1).

R1 was given pain medication on 10/16/24 and 10/17/24 according to what was found in the investigation the pain medication made R1 decompensate, and the pain medication was discontinued.

According to the Medication Administration Report (MAR) the medication was given on 10/16/24 and 10/17/24 and then ordered to stop and not to be given without consent.

During the investigation the medical power of attorney is found to be valid.

Based on interviews, observation, and record review, the above allegation is UNSUBSTANTIATED, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies were cited regarding the above allegation. An exit interview was held and a copy of this report was left with Nichols.