Complaint Investigation Report

515002949-7-10-2024-59-AS-TORZ-D7VW36-20240806165522

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

07/09/2024 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20240709103107

Facility staff not following mandated reporting requirements

LPA Hiratsuka conductedt this unannounced complaint visit.

LPA interviewed Administrator Leonard Willis. This complaint was made because a resident informed several staff of being inappropriate touched by another resident. Administrator didn't complete an SOC 341, Suspected Dependant Adult/Elder Abuse form. Administrator stated he did an investigation and didn't write down anything. LPA did speak to the resident in question but the incident itself cannot be proved or disproved.

As a result of this investigation, the Department finds the allegation above to be Substantiated. A finding that the complaint is Substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations.

Exit interview conducted. A copy of the report has been issued. LPA also left a copy of the Title 22 Regulation. Appeal Rights provided.