Complaint Investigation Report

392700603-10-11-2023-27-AS-LKIG-CWY8ZS-20231025225800

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO AC/SC , 2525 NATOMAS PARK DR. STE.270

This is an official report of an unannounced visit/investigation of a complaint received in our office on

07/31/2023 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20230731142003

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver complaint findings for the above allegations. LPA was greeted by staff and Melinda Womble joined 10 minutes later. LPA explained the reason for the visit.

Allegation 1 Resident was abused while in care is SUBSTANTIATED Based on interviews and records reviewed, R1 was grabbed by the wrist by S1.

This agency has investigated the allegation and has found the allegation to be substantiated meaning that there was a preponderance of evidence to prove the allegation was true.

The following deficiency was cited per Title 22 Provision 6 of the CA Code of Regulations.

An exit interview was conduct. A copy of this report along with appeal rights was given.