Complaint Investigation Report

471372608-2-14-2024-59-AS-KHOS-D39GN4-20240311052852

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

11/07/2023 and conducted by Evaluator Sarah Benson

COMPLAINT CONTROL NUMBER: 59-AS-20231107164442

Staff do not ensure that resident's medical and dental needs are being met while in care.

2/14/2024 1:30 PM Licensing Program Analysts (LPA) Sarah Benson made an unannounced visit to the facility and met with Administrator Erykah Timberlake-Small to deliver final findings regarding a complaint that was received on 11/07/23.

LPA interviewed the administrator, 1 staff and 7 client during the visit. LPA requested the following documents during the visit, admission agreements, physician reports and medical records.

The following deficiencies were observed (See LIC 9099D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, a copy of the report, and appeal rights provided.to administrator