Complaint Investigation Report

392701388-3-27-2026-27-AS-LKIG-DTEU8C-20260423152118

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

11/09/2025 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20251109215223

Staff neglect resulted in resident sustaining a knee laceration

Staff did not keep resident's authorized person informed about the resident's care

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 interviews and documents reviewed including the residents death certificate there was no mention of a laceration on the residents’ knee. Nor did the facility have pictures of any such laceration. All interviewed stated they resident would scratch herself and based on medical records reviewed the resident was proscribed an anti-tech medication. 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