Complaint Investigation Report

392701344-4-3-2025-27-AS-LKIG-DFTKW5-20250417081521

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

02/04/2025 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20250204143321

Licensee did not issue resident’s authorized representative a timely refund.

Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced todeliver findings for the complaint investigation. LPA Lewis met with facility administrator FLORES, OLIVER and explained the purpose of the visit.

Based on records review and interviews with the reporting party and the adminstrator the avove allegation is SUBSTAIATED. During the review of the admissions agreement it was found that an addmendment was added stating that if a resident was on hospice there was not refund to be given. A refund of 3200.08 is due to be refunded within 48 hours. There is a preponderance of evidence to conclude that the allegations noted above are SUBSTANTIATED.

Citations are issued as indicated on LIC 9099D. An exit interview was conducted Appeal rights provided