Complaint Investigation Report

502701180-9-3-2025-27-AS-LRIS-DNQTD7-20251124133751

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

08/29/2025 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20250829082834

Staff handled resident in a rough manner causing bruising.

Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to open a complaint. LPA Campbell met with Jackie Hernandez, Administrator and explained the purpose of the visit.

Regarding the allegation that staff handled resident in a rough manner, causing bruising, LPA Campbell interviewed staff, reviewed incident reports and images of the injury. Of the staff interviewed, (Staff 1, S2, S3 and S4) none reported that they had observed any staff treat Resident 1 roughly. However, S4 stated that R1 has a history of falls because "they are very indepenedent". When LPA Campbell reviewed In house Incident Reports,it was found that there had been several minor falls without injury since 11/2024. S5 also reported that R1 has a tendency to hit his arms on the bedrails. When asked, R1 stated the bruises happened when someone may have bumped into him but they could provide no further details.

Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore this allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, no deficiencies cited. Exit interview was held and a copy of report was given to Jackie Hernandez, Administrator.