Complaint Investigation Report

390314809-9-12-2025-27-AS-LKIG-DLJT29-20250915142023

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

09/11/2025 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20250911132141

Staff did not properly report incidents involving a resident to an authorized representative.

Staff are not providing access to a resident's records.

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to open an complaint for the above allegations. LPA was greeted by Executive Director and explained the reason for the visit.

LPA Lewis found that R1 is cared for in skilled nursing which is under Public Health tnot the department od social services. Therfore this complaint is unfounded.

A finding of unfounded means the allegation is false, could not have happened, or is without a reasonable basis.

Exit interview conducted. copy of report given.