Complaint Investigation Report

019201136-12-4-2025-15-AS-BFOG-DP8PJL-20251210102144

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

11/24/2025 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20251124131141

Staff did not provide a refund to resident.

On 12/4/2025 at 8:45 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 10 day initial complaint and deliver for the above allegations and met with care staff, Jason Salvador, Administrator (ADM) Dina Ramos was informed via phone regarding the purpose of the visit. ADM was not available during the time of the visit and gave permission to the care staff to sign the report.

Allegation: Staff did not provide a refund to the resident- Unfounded

During the course of the investigation, LPA confirmed that with S1, R1 resided at the facility after the change of ownership in July of 2025. R1 sided at the facility in the month of October 2025 – November 2025. This complaint finding is unfounded at this facility; however, it will be generated under the correct facility.

LPA has determined through staff interviews, documentation, and residents' LIC 604A that allegations are UNFOUNDED under this facility. A finding that is unfounded means the allegation is false, could not have happened, or is without a reasonable basis.

An exit interview is conducted a copy of this report is provided.