Complaint Investigation Report

392700729-12-12-2025-27-AS-LKIG-DQ2SWN-20260105131438

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

12/08/2025 and conducted by Evaluator Noel Wolf Petersen

COMPLAINT CONTROL NUMBER: 27-AS-20251208105831

Staff is posting videos of residents on social media without resident's consent.

Licensing Program Analyst Noel Wolf Petersen arrived unannouced on 12/12/25 at 12:00pm to conduct a complaint investigation into the above allegations. LPA met with administrator, Maxima Martine

LPA asked to review the admission agreement and any attached consents signed at admission. There are videos posted to the Facebook platform by facility staff featuring the facility and two residents for which have the residents have not signed consents to participate in. Administrator Provided there was not a consent form for publishing video of the care home or its residents in the admission agreement, and was aware of the videos and asked for the staff involved to stop.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. 2 citations from the California Code of Regulations,are being cited on the attached LIC 9099D.

A copy of the report was read and given to staff. Appeal rights Provided, and exit interview was conducted.