Complaint Investigation Report

507004748-7-30-2025-27-AS-LRIS-DKYSM3-20250828135917

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO SOUTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

04/17/2025 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20250417143444

Staff physically assaulted resident, resulting in multiple injuries.

On 07/09/2025, LPA Campbell arrived to the facility to close a complaint. LPA Campbell met with Joan Little and explained the purpose of the visit.

Regarding the allegation that staff physically assaulted resident, resulting in multiple injuries, LPA Campbell spoke with Staff 1 (S1) and S2. S2 stated that they had "grabbed" R1 by the wrists and ankles to prevent them going out the window and "set" them onto the bed. The statements from S2 also aligned with R1's report that S2 had "tossed" R1 onto the bed against their will. Images of R1's injuries were also observed..

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiency is being cited on the attached 809-D during this visit.

An exit interview was conducted, and copies of the report and appeal rights left.