Complaint Investigation Report

471372608-4-5-2024-59-AS-KHOS-D5YLBD-20240606083632

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

03/27/2024 and conducted by Evaluator Sarah Benson

COMPLAINT CONTROL NUMBER: 59-AS-20240327160846

04/04/24 1:00 PM Licensing Program Analyst (LPA) Sarah Benson, conducted an unannounced visit and met with administrator David Small House Manager. 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 administrator Sandee Crane. LPA observed couches with food and dirt stains, kittens under one couch, floors with dirt and pebbles and food wrapers. LPA observered and smelled a unclean oder.

Based on interviews and evidence obtained during the investigation, the preponderance of evidence standard has been met, 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 House Manager David Small and a copy emailed to administrator.