Complaint Investigation Report

392700225-6-22-2026-27-AS-LRIS-DVDLCX-20260625083901

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

06/19/2026 and conducted by Evaluator Arielle Pascua

COMPLAINT CONTROL NUMBER: 27-AS-20260619142753

On 06/22/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA Pascua was greeted by Tenant, Rachelle Bradshaw. LPA Pascua identified herself as a representative from Community Care Licensing, explaining that this property was a licensed facility. It was determined at this time that the tenant has resided at the property since June 9, 2026. LPA Pascua attempted to contact the property owner, however, the phone number on file was out of service, and contact could not be established.LPA Pascua toured the property to verify that there were no residents currently receiving care at the location. Additionally, a copy of the rental agreement was reviewed and obtained.Based on the information gathered during the investigation, the facility licensee has lost control of the property. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.An exit interview was conducted and a copy of this report and appeals rights will be certified mailed to the licensee.