Complaint Investigation Report

397003771-7-24-2026-27-AS-LKIG-DWQVF3-20260807162317

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

05/27/2026 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20260527133538

Staff did not prevent resident(s) from developing a pressure injury

Staff do not ensure resident receives medical attention in a timely manner

Staff administer medication without a doctor's prescription

Staff do not ensure that resident is assisted with glucose testing

Staff places residents on hospice care without residents consent

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 wellness Director and explained the purpose of today's visit.

Based on the records reviewed, staff interviews along with facility tour and tour of the medication room. 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.