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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700701
Report Date: 08/13/2025
Date Signed: 08/13/2025 10:28:13 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/07/2025 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20250507163336

FACILITY NAME:ASIANA RESIDENTIAL SERVICESFACILITY NUMBER:
502700701
ADMINISTRATOR:KHAN, SAJIDAFACILITY TYPE:
735
ADDRESS:5020 TAMARA WAYTELEPHONE:
(209) 566-3933
CITY:SALIDASTATE: CAZIP CODE:
95368
CAPACITY:6CENSUS: 6DATE:
08/13/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Sabrina Sanchez TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff inappropriately groomed resident causing discomfort
INVESTIGATION FINDINGS:
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Staff inappropriately groomed resident causing discomfort- LPA Lund reviewed facility paperwork, interviewed staff, reporting party, and witnesses. LPA Lund reviewed facility paperwork and IPP’s for Client (C1) and Client (C2). Both clients are nonverbal and cannot give consent for any type of grooming. The facility didn’t have a formal Individual Development Team meeting before they groomed both clients. Interviews with staff, reporting party and witnesses stated they could not state that the grooming was the cause of the discomfort. LPA Lund attempted to interview clients but are nonverbal
Based on reviewed facility records, interviews reporting party, staff and clients in care the information provided, it was unclear if staff inappropriately groomed resident causing discomfort therefore, the allegation was deemed UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20250507163336
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ASIANA RESIDENTIAL SERVICES
FACILITY NUMBER: 502700701
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
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On 8/28/2025 LPA Lund ameded the complaint Deficency page.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20250507163336
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ASIANA RESIDENTIAL SERVICES
FACILITY NUMBER: 502700701
VISIT DATE: 08/13/2025
NARRATIVE
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As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and copies of the report and appeal rights left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5