Complaint Investigation Report

397005466-12-14-2023-27-AS-LRIS-CYNTGP-20231219134325

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

08/24/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230824115015

Nicole Bacon, Assistant Executive Director

On 12/14/23, Licensing Program Analyst (LPA) Renee Campbell made an unannounced visit to facility at approximately 12:45 pm. LPA Campbell discussed the purpose of the visit and the elements of the allegation with Assistant Executive Director Nicole Bacon.

Regarding the allegation that staff do not properly store food, prepared desserts were observed by LPA Campbell to be stored uncovered in the refrigerator.

Based on LPA’s observations and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiency is being cited on the attached 809-D during this visit.

An exit interview was conducted, and copies of the report and appeal rights left.