Complaint Investigation Report

392700993-1-12-2024-27-AS-KHOS-D3PL7C-20240325083007

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

10/05/2023 and conducted by Evaluator Albert Johnson

COMPLAINT CONTROL NUMBER: 27-AS-20231005125740

Eddie Itliong and Elizabeth Phitsanovkanh

On 1/12/24, LPA Johnson arrived to deliver findings for the above listed allegations. LPA met with Staff. The department investigated the questionable death allegation and discovered that R1's cause of death was listed on R1's death certificate as cardiac arrest and senile degeneration of the brain. There were no other significant conditions contributing to R1's death and no indication there was anything questionable about R1's death. Review of R1's medication administration record did not indicate R1 was being given any excessive amounts of Lorazepam.

The department has investigated the complaint alleging an questionable death. The department has found that the complaint is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.