Complaint Investigation Report

397001473-1-2-2026-27-AS-LKIG-DQQ342-20260126165425

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

11/17/2025 and conducted by Evaluator Noel Wolf Petersen

COMPLAINT CONTROL NUMBER: 27-AS-20251117151432

Facility did not get permits from the city or county to add on or build onto the facility.

LPA arrived unannounced, to the facility, 1/2/2026, to deliver findings of a complaint investigation. LPA met with the administrator Tor Renedor to explain the purpose of the visit.

LPA reviewed files, the original facility sketch and submitted changes, and found it matched the building in approximation with the current facility sketch. Interview with the fire marshal, the building is not fire cleared. Interviews with the Administrator provided that the changes to the garage in 2013 were permited, but the changes to the staff room were not. LPA updated the fire marshal, Licensee will take steps to follow up until the building is fire cleared.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations is being cited on the attached LIC 9099D

Citation issued on following d-page. appeal rights provided. a copy of the report was read and given to staff, exit interview conducted.