Complaint Investigation Report

500310664-5-16-2024-27-AS-KHOS-D6KNU2-20240625104536

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

03/26/2024 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20240326121327

Sister Basima Margaret Homa, Administrator

Staff did not ensure that the facility is free of hazards

On 05/16/24, LPA Renee Campbell arrived to the facility regarding a complaint filed on 03/26/2024. LPA Campbell met with Administrator, Sister Basima Margaret Homa and explained the purpose of the visit.

It was alleged that staff did not ensure that the facility is free of hazards. LPA Campbell took images of R1’s room with several extension cords on the floor obstructing pathways after a power outlet outage on approximately 03/25/24. S2 stated that extension cords were split and combined with other cords when they no longer worked and were then wrapped with electrical tape. LPA Campbell also recorded images of split cords wrapped with tape and then stored in the facility garage.

Based on the information provided through interviews and observation, the allegation that the facility did not ensure the facility is free of hazards is SUBSTANTIATED. The following deficiency was cited per Title 22 Division 8 Section 8 of the California Code of Regulations. An exit interview was conducted with Sr. Basima Margaret Homa and a copy of this report was left with the administrator.