Complaint Investigation Report

502701379-4-17-2026-27-AS-LKIG-DTZSCN-20260512134550

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

04/01/2026 and conducted by Evaluator Noel Wolf Petersen

COMPLAINT CONTROL NUMBER: 27-AS-20260401105300

Licensing Program Analyst, LPA, Noel Wolf Petersen, arrived to the facility to conduct a complaint investigation, 8am, 4/17/26. LPA met with Genaro Basiac to explain the purpose of the visit

The allegation of false claims was clarified to be a staff falsely represented as another person, through administrator interview and a review the staff records for the employes and LIC500, it was learned that staff records were not complete for 4 staff, and in one instance the a employee was not added to the staff roster to obfuscate that her fingerprinting status was not complete.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D.

A copy of the report was read and given to the administrator with the appeal rights, an exit interview was conducted.