Complaint Investigation Report
397005571-8-18-2025-27-AS-LRIS-DKYSGZ-20250828135246
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
05/13/2025 and conducted by Evaluator Albert Johnson
COMPLAINT CONTROL NUMBER: 27-AS-20250513161533
Licensing Program Analyst (LPA) Albert Johnson conducted a facility visit to deliver findings for the above allegations.
Allegation: Staff mismanaged client's funds. Records reviewed confirmed that the allegation is substantiated, the facility's record of client/resident 's safeguarded cash resources form includes withdrawn amounts shown twice for the same amount ($45.11) for on-line shopping; one dated 2/22/2025 and the other is without a date labeled as "online order money pulled ($45.11)" and the wrong amount carried over ($282.74) for 2/20/2025 cash on hand. Based on this information the balances for the period of 2/20/2025 through 6/12/2025 are not settled.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction