Complaint Investigation Report

392700306-9-19-2025-27-AS-LKIG-DLRV77-20250922161041

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

07/25/2025 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20250725100252

Licensee did not ensure that resident was receiving showers as necessary.

Licensee did not ensure that resident's adult briefs were changed and that the resident was kept clean and dry

On 09-19-25, Licensing Program Analyst (LPA) Kesha Lewis and Licensing program manager Liza King arrived unannounced to continue the complaint investigation for the allegations noted above. LPM/LPA met with the administrator and explained the purpose of the visit.

LPM requested five (5) resident ADL'S sheets. Based on records reviewed three (3) out of the five (5) residents did not have a shower in the month of July 2025. While walking down the hall a malodorous smell was present in the facility during today’s visit and LPA Lewis observed the same smell during a during a different visit to the facility. Therefore, the allegation that the Licensee did not ensure that resident was receiving showers as necessary and Licensee did not ensure that resident's adult briefs were changed, and that the resident was kept clean and dry 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 are being cited from the California Code of Regulations (CCR) and/or the Health and Safety Code.

An exit interview was conducted, and a copy of this report and appeal rights were given.