Complaint Investigation Report

392700306-9-19-2025-27-AS-LKIG-DLRV6F-20250922160928

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

07/08/2025 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20250708130945

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.

Based on observation the facility has four (4) hoyer lifts and only three (3) of them were working during the visit. The facility was having to use another residents lift to move other residents. therefore the allegation Facility's equipment is in disrepair is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met.

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