Complaint Investigation Report

392701388-10-7-2025-27-AS-LRIS-DNQPGW-20251124101902

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

06/04/2025 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20250604161942

Facility failed to administer medications.

On 10/07/2025, Licensing Program Analyst (LPA) Kesha Lewis arirved unannounced to continue the complaint investagation.

R1 moved out of the facility on 6/18/2025, and was amitted on 4/30/2025. R1 required inslin and was unable to administer the medication on their own. LPA reviewed R1's 602, needs and service plan and the medication adminstration recordss from addmission to move out. Based on records reviewed and interview with staff the allegation Facility failed to administer medications is SUBSTANTIATED. R1 was givin an inslin injection by staff. There are also days the facility did not have medication for R1. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Exit interveiw and copy of report and appeal rights given.