Complaint Investigation Report

397005466-7-24-2026-27-AS-LKIG-DWLM69-20260803091935

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

05/11/2026 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20260511154015

Staff are not reporting incidents to authorized representatives

Due to lack of staff, residents are left unattended

Staff are not assisting residents due to lack of staff

On 07/24/2026, Licensing Program Analyst (LPA) Kesha Lewis conducted an unannounced facility visit to deliver findings for complaint for the above allegations. LPA met with Health and wellness Director and explained the purpose of today's visit.

Based on the records reviewed that show there is 4 care givers and two medication tech and LVN on call at night and during the day there is no less then 5 care givers one LVN and two med techs, and interviews with authorized representatives that confirm they were notified of an insident with their family member. The allegations above are UNSUBSTANTIATED. A finding of unsubstaniated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the facility.