Complaint Investigation Report

019201341-12-16-2025-15-AS-BFOG-DPHQQE-20251219112214

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

E BAY DELTA AC/SC , 1515 CLAY STREET, STE. 310

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

12/11/2025 and conducted by Evaluator Lori Alexander-Washington

COMPLAINT CONTROL NUMBER: 15-AS-20251211101359

Staff did not ensure medications were locked and inassesable to residents

On 12/16/2025 at 12:50 PM Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct an initial 10-day complaint investigation in regards to the allegations above. LPA called Licensee/Administrator, Thinn Aye, and explained the purpose of the visit over the phone. Thinn gave authorization for caregiver, Khin Win, to sign the report.

During the visit LPA toured the facility with Staff (S1) and observed that the individual locks on each locker that holds the residents' medications were not securely locked. LPA observed that the shower floors were not clean.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted with Khin Win. Appeal rights and copy of this report provided.