Complaint Investigation Report

392700516-10-16-2024-27-AS-KHOS-DA9PQ7-20241021113041

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

07/30/2024 and conducted by Evaluator Albert Johnson

COMPLAINT CONTROL NUMBER: 27-AS-20240730145630

This is a repeat of an allegation that was substantiated on 9/17/2024.

During the course of investigation, LPA collected documents and conducted interviews. The department confirmed that an employee reported that R1 said S1 punched him in his eye on 7/18/24 during an incident involving S1 and R1 that was initially reported as aggressive act to staff from resident. S1 reported that R1 said he did not feel safe with S1. The employee believes R1 is intimidated by the Operations Manager and was afraid to be truthful. R1 was initially interviewed by Operations Manager Denica Layne on 7/19/24. R1's right eye was swollen and he had a dark bruise under his right eye. R1 refused to go to the hospital. The plan of correction was completed by the facility on 9/18/2024. Therefore, there will not be a 9099D page.