Complaint Investigation Report

392700640-5-4-2026-27-AS-LRIS-DUBPBW-20260522111101

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

01/20/2026 and conducted by Evaluator Albert Johnson

COMPLAINT CONTROL NUMBER: 27-AS-20260120135713

Facility is operating outside of license terms and conditions

Allegation: Facility is operating outside of license terms and conditions. Based on records reviewed the facility is operating within the scope of the license. The information provided in the Physician's reports and hospice notes for the residents in question does not support the alleged. The residents were on hospice and were receiving service from the hospice agency. The mandate to report information is required during the time of employment and is not to be used as retaliation. The allegation is unsubstantiated.

Allegation: Staff overcharged resident in care. Records reviewed confirm that the facility is charging for services provided based on assessments. The information reviewed outline the needs and services for each resident reviewed and is up-to-date. The alleged misconduct was an agreement between the resident /resident's family and the facility to place a hold on the apartment until that resident was ready to return from her medical emergency and back to baseline.