Complaint Investigation Report
455002675-2-21-2024-59-AS-KHOS-D32MST-20240304085227
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
02/12/2024 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20240212141923
Facility staff did not administer resident's medication as prescribed.
02/21/2024 1:30 PM Licensing Program Analyst (LPA) Sarah Benson, conducted an unannounced visit and met with Naomi Alves. The purpose of this visit was to open a complaint investigation. During today's visit the facility was toured, records were reviewed and interviews were performed.
LPA interview care staff Naomi Alves.. LPA requested the following documents during the visit: staff list with telephone numbers, client admission agreement, medical records, medical administration records, PRN records and incident reports.
Unfounded: Report was recorded at wrong facility.
No deficiencies cited. Exit interview conducted and a copy of the report was provided to care staff Naomi Alves.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction