Complaint Investigation Report

502701180-7-15-2025-27-AS-LRIS-DLRLJ4-20250922084720

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

07/09/2025 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20250709140117

Staff did not ensure resident’s signaling equipment was maintained in operable condition.

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

Regarding the allegation that staff did not ensure resident’s signaling equipment was maintained in operable condition, LPA Campbell observed that notifications were not heard or responded to by staff. LPA Campbell observed that when R9 pulled their cord, the call was received by the Memory Care phone but could not be heard. When asked, S4 stated that they had been experiencing problems with the Memory Care phone receiving notifications from residents.

Based on LPA’s observations and interviews which were conducted, 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.