Complaint Investigation Report

397005738-8-28-2024-27-AS-KHOS-DAGK4W-20241028073458

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

07/24/2024 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20240724154542

On 8/28/2024 at 10:27am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the complaint allegation noted above. LPA met with Administrator William Puckett and explained the purpose of the visit. During this investigation, LPA conducted interviews with six staff members and two residents in care. LPA also conducted a facility observation and reviewed additional facility file documentation. Based on interviews and record reviews it was determined that on 7/23/24 a facility staff member “addressed a consumer in a less than professional manner by using a harsh tone while speaking to the consumer.” Interviews conducted also corhaborrated the event. As a result, the preponderance of evidence standard is met and this allegation is SUBSTANTIATED. Citation is issued under Title 22, Division 6 and noted on LIC 9099D. An exit interview was conducted with William Puckett and a copy of this report was provided to William. Appeal rights provided. LIC 811 provided.