Complaint Investigation Report

392700475-5-15-2025-27-AS-KHOS-DJFLAR-20250710083533

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

05/13/2025 and conducted by Evaluator Albert Johnson

COMPLAINT CONTROL NUMBER: 27-AS-20250513191306

Staff are charging resident for a higher level of care than what is received

Licensing Program Analyst (LPA) Albert Johnson arrived at facility unannounced to open a complaint investigation into the above listed allegation and deliver findings.

Based on records reviewed and interviews conducted the facility is not following their approved plan of operation. The facility's plan of operation submitted to the department has been amended to include a new level of care description and fees. The facility has implemented this new level of care descriptions and fees without submitting to the licensing agency for approval prior to implementation.

Based on records reviewed and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The facility has been cited for this violation on 5/08/2025 control number 27-AS-20250508090354. Therefore a 9099D pages will not be included in this report. The facility will include this finding into the plan of correction for the complaint dated 5/8/2025. Exit interview conducted and a copy of this report was given with appeal rights.