Complaint Investigation Report

500305863-12-12-2024-27-AS-KHOS-DCPNH3-20250107092801

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

08/08/2024 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20240808070850

Facility staff not following infection control practices

Facility staff not properly cleaning dishes

On 12/12/2024, Licensing Program Analyst Renee Campbell arrived to the facility to deliver findings regarding a complaint. LPA Campbell was met by Georgia Wilcomb, Licensee and explained the purpose of the visit.

Regarding the allegation that facility did not follow infection control practices, based on intervew with C1, staff did not wear masks during a COVID outbreak in the facility.

Regarding the allegation that staff did not properly clean dishes, based on interview with S1 and C4, because C4 liked to "stay busy" by doing dishes, C4 would do the dishes directly after dinner. However, S1 stated that because C4 did not clean them well enough, staff had to do the dishes again after C4 washed them.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809-D during this visit. An exit interview was conducted, and copies of the report and appeal rights left.