Complaint Investigation Report

019201143-9-16-2024-15-AS-KHOS-D9FSMH-20240925135957

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1515 CLAY STREET, STE. 310

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

08/14/2024 and conducted by Evaluator Lisha Holmes

COMPLAINT CONTROL NUMBER: 15-AS-20240814132320

On 09/16/2024 Amended report to correct the allegation:

On 08/21/2024 around 09:30 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an initial 10-day complaint visit and closed the complaint for the above allegation. LPA met with Mary Anne Watral, Operations Specialist (OP) and Douglas Blake, Executive Director (ED) and explained the purpose of the visit.

Deficiency was cited on LIC809D on 08/21/24 under the annual inspection.

Exit interview conducted. A copy of this report and appeal rights were provided to ED.