Complaint Investigation Report

455002607-12-6-2023-59-AS-KHOS-CZ7QWW-20240105113238

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

12/04/2023 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20231204164501

Staff handled a resident inappropriately.

LPA Hiratsuka conducted this unannounced complaint visit.

LPA interviewed staff and residents. Interviews confirmed Staff (S1) put a resident into a transport van to prevent the resident from lashing out at others but did not handle the situation appropriately. S1 does not have any training on physical restraints.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the allegation is found to be Substantiated. California Code of Regulations (Title 22) is being cited on the attached LIC 9099D.

Appeal rights are provided, and a closure interview was conducted.