Complaint Investigation Report

502701078-1-9-2025-27-AS-LRIS-DDCQX5-20250128113259

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

10/09/2024 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20241009141151

Client sustained unexplained bruising while in care

On 01/09/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility for a complaint. LPA Campbell met with Nadia Falconer and explained the purpose of the visit.

Regarding the allegation that a client sustained unexplained bruising while in care, the bruise was observed by R1’s day program on October 1, 2024. S1 stated that the source of the bruise was unknown and assumed to be from behaviors exhibited from the prior weekend. R1's responsible party confirmed that they had received the same information from the facility.

Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, 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.