Complaint Investigation Report
502701087-4-12-2024-27-AS-LRIS-D4DPG3-20240416111738
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
02/23/2024 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20240223144547
Licensee did not provide POA a copy of the signed Admission Agreement
On 4/12/24 at approximately 12pm Licensing Programm Analyst (LPA) Maja Jensen arrived at facility unannounced to deliver findings related to the above listed allegations. LPA Jensen met with Angela Chicas and explained the purpose of today's visit.
On 3/1/24 LPA Jensen interviewed the Licensee by telephone. The Licensee, Bonaire Yepez, confirmed that she did not provide a copy of the Admission Agreement to the resident's Power of Attorney upon signing however she was willing to provide a copy of the agreement at any time after admission upon request. The Licensee/Administrator also stated that she was not aware that providing a copy of the admission agreement was a regulatory requirement. Based on the interview with the Licensee/Administrator the allegation of "Licensee did not provide POA a copy of the signed Admission Agreement" is SUBSTANTIATED. A finding of substantiated means that the preponderance of evidence standard has been met. Deficiencies are being cited pursuant to the the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct Deficienices may result in the assessment of civil penalties. An exit interview was conducted and a copy of this report and appeal rights were provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction