Complaint Investigation Report

455002976-3-28-2023-59-AS-KHOS-CSQPFC-20230612111627

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 2525 NATOMAS PARK DR STE 270

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

03/24/2023 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20230324141842

LPAs Hiratsuka and Avila, conducted this unannounced complaint visit. LPAs wore a surgical mask and observed alls staff wearing masks.

LPAs reviewed the resident in question's file. The file is missing the following: admission agreement, completed pre-appraisal, personal rights, client personal belongings inventory list, medical release, and consent forms. The resident moved in the beginning of this month and the file is not complete.

Based on the above, the allegation is substantiated.

Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights left