Complaint Investigation Report

455002744-1-23-2024-59-AS-KHOS-D3XPSY-20240402113506

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

01/18/2024 and conducted by Evaluator Ivan Avila

COMPLAINT CONTROL NUMBER: 59-AS-20240118155917

On 01/23/2024, Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegation directed by the Department. LPA Avila met with staff member Josiah Henderson and explained the reason for the visit.

LPA toured R1s bedroom and observed two doorknobs that were covered. The covers for the doorknobs are ones that cover it and to open the doorknob there were a couple of places for the fingers to press that created pressure between the cover and the doorknob and the doorknob could open. R1 is diagnosed with dementia and can not open the door without assistance. The doorknobs that were covered are designated exits. Because it is a designated exit an immediate $500 civil penalty was issued. The doorknob covers were removed during visit.

Based on observation, 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. Appeal Rights provided.

Exit interview was conducted and copy of the report was provided..