Complaint Investigation Report

390314809-8-28-2025-27-AS-LKIG-DLJST8-20250915140908

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

06/10/2025 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20250610162605

Licensee does not ensure that skilled professional provides injections to residents

Licensing Program Analyst (LPA) Kesha Lewis contacted Administrator Dawn Shimel on this day to conclude a complaint investigation. LPA explained the purpose of the visit.

Based on interviews and documentation with the Human resources Manager and the Human recourses generalist and administrator the allegation Licensee does not ensure that skilled professional provides injections to residents is Unsubstantiated. The administrator was able to provide documentation that the facility has on staff an RN and two (2) LVN'S. A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted and a copy of the report provided.