Complaint Investigation Report

019200973-9-4-2025-15-AS-HHUL-DLDLGM-20250910084454

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

03/04/2025 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20250304113131

Facility staff do not remain awake during overnight shifts

On 9/4/2025 at 10:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and deliver findings in regards to the allegation above. LPA met with Manager, Rachell Paniagua and explained the purpose of the visit.

During the course of investigation, LPA interviewed resident, staff, and witnesses. LPA obtained and reviewed documents including physician's report, emergency information, staff schedule, and incident reports. Interview with witnesses revealed that R1 was discharged from hospital at around 1:00AM on 3/4/2025 and transported back to the facility via ambulance. Witnesses stated ambulance rang the facility bell for about an hour without response from facility staff and ambulance took R1 back to hospital around 3:00AM on 3/4/2025.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted with Rachell Paniagua. A copy of this report and appeal rights provided.