Complaint Investigation Report

342700266-7-22-2024-27-AS-KHOS-D83NQ6-20240812103924

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

05/15/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20240515152858

Care staff threw a backpack at resident hittimg him in the face.

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver complaint findings for the above allegations. LPA was greeted by administrator and explained the reason for the visit.

Based on interviews with staff and residents the alleagation is Substantiated. S1 and S2 confirm that R1 had their backpak thrown at them, and as a result R1 was hit in the face. The department has investagaged this complaint and the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 6, deficiencies are being cited on the attached 9099D during this visit.

If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. A copy of their rights was provided (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was given.