Complaint Investigation Report

392700661-1-8-2025-27-AS-KHOS-DD5R85-20250121114721

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

12/11/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20241211084125

Absense of staff when resdients are present

On 01/08/25, Licensing Program Analyst (LPA) Kesha Lewis and Licensing program manager (LPM) Liza King arrived unannounced to continue the complaint investagation for the allegations noted above. LPA met with staff explained the purpose of the visit.

LPA interviewed R1-R2 and S1. LPA Lewis toured facility to ensue complince with title 22 regulations.

Based on observations and interviews with residents and the a visit from valley mountian reginal (VMRC) on 12/06/2024 During the visit from VMRC residents were found to be in the facility with no staff by VMRC legasion Isebella Dalman.

the complaint is determined to be SUBSTANTIATED. As a result, the preponderance of evidence standard for this allegation is met, therefore, this allegation is SUBSTANTIATED.

Deficiencies cited see 9099D page per California Code Regulation, TITLE 22.

Exit interview was conducted and a copy of the report and appeal rights given.