Complaint Investigation Report

507000307-1-12-2024-27-AS-KHOS-CZJMGL-20240116083608

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

10/09/2023 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20231009145007

Resident was attacked by another resident

Licensing Program Analyst (LPA) Kesha Lewis arrived at the facility unannounced to deliver findings for the above allegations. LPA was greeted by buniess office manager and explained the reason for the visit.

Allegation 1 Resident was attacked by another resident is UNSUBSTANTIATED. Based on information gathered both residents are not able to clearly state what might have happened based on there dignosies and R2 has passed way.

LPA was not able to find the allegation did or did not occur. Due to the information gathered LPA finds allegations to be UNSUBSTANTIATED. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

An exit interview was held and a copy of this report was given.