Complaint Investigation Report

392700225-11-24-2025-27-AS-LRIS-DS5LY9-20260313090958

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

11/20/2025 and conducted by Evaluator Albert Johnson

COMPLAINT CONTROL NUMBER: 27-AS-20251120130750

On 11/24/2025, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to this facility to conduct a complaint investigation.

Based on a facility visit conducted by Ombudsman officials on November 20, 2025, at approximately 12:10 p.m., the facility was found to be without staff present. Ombudsman officials checked the premises and confirmed with R1 that S1 had left to go to the store. The facility was secured by the two Ombudsman officials during their visit. The Department was contacted regarding the situation, and law enforcement was notified; however, law enforcement was redirected to an emergency before a report could be made and subsequently left the scene. S1 returned to the facility at 1:02 p.m. and explained they needed to obtain important items. Substantiated