Complaint Investigation Report

455920054-9-24-2025-59-AS-LCRR-DLEM7X-20250911092215

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

06/24/2025 and conducted by Evaluator Sarah Benson

COMPLAINT CONTROL NUMBER: 59-AS-20250624151023

On 9-04-25 Sarah Benson, Licensing Program Analyst (LPA), arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 06-24-25. LPA Benson met with Administrator Jessica Boarman and explained the purpose of the visit.

During the interview process staff and residents were interviewed. Documents were received and reviewed to include the client list, staff list with telephone numbers, Resident and Staff Files, Client Admission Agreements, Individual Program Plans (IPPs), Medical records and Police reports.

The department has conducted extensive interviews and a thorough investigation. Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, the resident was assaulted by staff, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Appeal rights were provided. An exit interview was conducted. A copy of the report was provided to Administrator Jessica Boarman. LPA Benson advised that a Non Compliance Conference will be scheduled. The licensee was informed that an immediate civil penalty of $500 shall be assessed for violation of California Health and Safety Code §1569.49.