Complaint Investigation Report

515002765-4-24-2023-25-AS-KHOS-CSCR52-20230531124226

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 2525 NATOMAS PARK DR STE 270

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

01/03/2023 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 25-AS-20230103141558

Facility not communicating with responsible party

LPA Hiratsuka, conducted the investigation into the allegation above.

LPA interviewed staff and the complainant. Administrator Assistant Ivy Garner stated she did not notify the responsible party of the missing item because she thought it was communicated to the responsible party by another family member of the resident in question. Facility had already contacted the doctor to make adjustments to the resident's dietary needs.

Based on the above, the allegation is substantiated.

Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights left