Complaint Investigation Report

455002787-2-18-2026-59-AS-LCRR-DWHSDD-20260731134654

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

01/06/2026 and conducted by Evaluator Marisa Chiarelli

COMPLAINT CONTROL NUMBER: 59-AS-20260106100114

Staff did not comply with reporting requirements.

On 02/18/2026, Marisa Chiarelli, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 1/06/26. LPA Chiarelli met with Adminstrator Michael Lang, and explained the purpose of the visit.

On 2/11/26 community care licensing received a fax that contained incident reports from 1/12/26, 1/16/26, and two incidents reports from 1/17/26. Based on incident reports dates of incident occurring and date it was submitted to CCL, the allegation “staff did not comply with reporting requirements” is Substantiated.

Exit interview conducted. Copy of report given to facility.