Complaint Investigation Report

500310664-9-5-2024-27-AS-KHOS-D9MTUB-20241001150204

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

07/03/2024 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20240703144147

Camille Duralski, Administrative Assistant

On 09/04/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to present findings for a complaint. LPA Campbell met with Camille Duralski, Administrative Assistant and explained the purpose of the visit.

Regarding the allegation that staff unlawfully evicted a resident, no record of a documented eviction notice was found. When F1 was contacted, they reported there had been no discussion of eviction. C1 also stated that no eviction notice was issued. The client was also admitted back to the facility per the notice provided by the administrator.

Based on the information collected there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. 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(s) 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 Camille Duralski.