Complaint Investigation Report

455002744-3-26-2024-59-AS-KHOS-D3XPSX-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 Jaynae Boyles

COMPLAINT CONTROL NUMBER: 59-AS-20240118155917

03/26/2024, Licensing Program Analyst Jaynae Boyles made an unannounced visit to the facility and met with administrator. The purpose of this visit was to deliver the results of a complaint investigation.

LPA reviewed the following documents: LPA reviewed the files of all residents including, admissions agreement, preplacement appraisal, admissions policies. LPA reviewed incident reports that have been submitted to CCL in the last three months. During the course of the investigation the administrator and two staff were interviewed. The resident was not interviewed due to his dementia status.

During the investigation, it was reported that a resident fell during the nighttime shift and was unattended to. Staff were interviewed, and it was reported that there is an awake nighttime staff person that regularly checks on the residents. Staff advised that they were not aware of a resident falling and not being attended to. Staff advised that overall, staff are able to meet the needs of the residents. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was provided to administrator.