Complaint Investigation Report

455002663-8-14-2023-59-AS-KHOS-CUSH8S-20230817055850

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

08/04/2023 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 59-AS-20230804113841

Staff did not take measures to keep the facility free of insects.

On 08/14/23 Donna Gurriere and Jaynae Boyles, Licensing Program Analysts (LPAs) arrived at the facility unannounced to discuss the above mentioned allegation. LPAs met with Jacobb Nuss, Administrator and explained the purpose of the visit.

Upon arrival at the facility, it was stated that the pest control person was just at the facility to spray indoors for insects/bed bugs. It was noted that this is the first attempt to get rid of the insects and that the pest control person will come back again to check and possibly spray a second time.

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