Complaint Investigation Report

392700306-8-13-2024-27-AS-KHOS-D8BQG2-20240820120849

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

08/12/2024 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20240812112738

Staff did not report incident to resident's responsible party

Licensee does not provide a resident and responsible party with a reappraisal meeting

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 leaned during the visit that R1 did not reside at this facility but at a skilled nursing facility that is located on the same property. No investigation done. Allegation is unfounded.

An exit interview was held and a copy of this report was given.