Complaint Investigation Report

507001187-5-12-2026-27-AS-LRIS-DUBPXK-20260522114229

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

03/26/2026 and conducted by Evaluator Arielle Pascua

COMPLAINT CONTROL NUMBER: 27-AS-20260326163018

Uncleared staff providing care to the residents

On 05/12/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings for the allegation above. LPA Pascua met with Facility Designated Administrator (FDA), Marinela Placintar and explained the purpose of the visit.

Current census was 6. A brief interview with FDA Placintar.

It was alleged that there is an uncleared staff member providing care to the residents.. Based on information gathered, the determination of the exclusion order of S1 is still pending, however S1 is able to be present in the facility at this time.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time. An Exit Interview was conducted and copy of this report was provided to the facility at the end of this visit.