Complaint Investigation Report

397005571-12-16-2023-27-AS-LRIS-CYQNQJ-20231221094003

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

08/22/2023 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20230822085356

Facility staff is not providing residents with adequate care and supervision.

On 12/16/23, Licensing Program Analyst arrived to the facility unannounced at approximately 11:15 am to deliver findings regarding a complaint investigation. LPA Campbell met with Administrator Susan Lo and stated the purpose of the visit.

Regarding the allegation that facility staff is not providing residents with adequate care and supervision,per the 602, R1 could leave unassisted. However, R2 and S1 stated that R1 left on the same day that they were admitted to the facility and no staff saw them leave. R2 reported that R1 did not speak to anyone and had no altercations on the day that they left. S1 reported that staff did not follow the resident off the facility grounds and R1 never returned to the facility.

The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 6, deficiencies are being cited on the attached 9099D during this visit. If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. A copy of their rights was provided (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided.