Complaint Investigation Report

397005745-6-26-2024-27-AS-LKIG-D7P273-20240730170804

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

05/03/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20240503093727

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver findings for the above allegations. LPA was greeted by staff licensee jaind about 20 minutes later. LPA explained the reason for the visit.

LPA Lewis conducted a facility tour and observation. LPA conducted facility tour with administrator LPA observed facility common areas, various resident rooms, kitchen area and hallways. Facility was observed to contain no foul odors.Fire extinguisher was full charged and dated 2-26-24. Room temperature was 76*F. Smoke alarms and carbon detectors are functioning properly. Current census is 6. No obstructions to fire exits noted during today's tour. LPA observed a lock on the pantry door to have been turned around and to be unlocked residents are able to opend at will. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. On 5/03/2024 .

Exit interview conducted. Copy of report given.