Complaint Investigation Report

392701388-3-27-2026-27-AS-LKIG-DTEU7H-20260423151959

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

01/14/2026 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20260114165215

Resident sustained an unexplained injury while in care.

Staff did not ensure that resident's room is cleaned.

Staff did not notify resident's responsible party of an injury.

Staff are not meeting resident's hygiene needs.

On 03/27/26. Licensing Program Analyst (LPA) Kesha Lewis and Licensing program manager (LPM) Liza King made an unannounced visit to this facility to deliver findings for the above allegations. LPA and LPM identified themselves upon arrival, stated the purpose of their visit, and asked to meet with the Designated Facility Administrator.

Based on LPA'S observation of the resident 1 and their room The resident was clean and hair their hair was done. R1'S room was clean and sanitary. . Therefore, this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Administrator, and a copy of this report was provided. Appeal rights and LIC 811 provided.