Complaint Investigation Report

397002232-1-17-2024-27-AS-KHOS-CZZKW8-20240131071530

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

01/08/2024 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20240108092143

Staff do not maintain a comfortable temperature for residents at all times

On 1-17-24 at 10:22am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate the complaint allegation noted above. LPA met with Licensee Nellen Van De Pol and explained the purpose of the visit. During this investigation, LPA conducted a facility observation. LPA also interviewed Licensee and three residents in care. During investigation, LPA observed thermostat displaying temperature at 66*F with set temperature at 75*F. Interviews conducted also revealed that facility temperature is not maintained between 68*F and 85*F per regulatory requirements during various times of the day and night.

As a result of this investigation, there is a preponderance of evidence to concluded that facility did not maintain the regulatory temperature of 68*F and 85*F, therefore this allegation is SUBSTANTIATED. CItation is issued under Title 22, division 6. An exit interview was conducted with Staff2 (S2) and a copy of this report was provided to S2. Licensee Nellen Van De Pol departed facility prior to completion of investigation and gave permission for S2 to sign in her absence. Appeal rights provided.