Complaint Investigation Report

019200464-12-30-2025-15-AS-YFLS-DQ3PFQ-20260106101706

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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 Ardalan Gharachorloo

COMPLAINT CONTROL NUMBER: 15-AS-20251211133328

Licensee did not maintain adequate emergency supplies as required

On 12/30/2025 at 1:20 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings in regard to the allegation above. LPA met with Administrator Ho Fung and explained the purpose of the visit.

During the course of the investigation, the LPA toured the facility and confirmed that W1 had previously visited the facility . W1 stated that at the time of that visit, the facility did not have an emergency water supply available for residents. During the LPA’s visit, S1 was interviewed and stated that after W1’s visit, the facility purchased and obtained an emergency water supply.

Based on LPAs observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety code section 1569.695(a)(2) is being cited on the attached LIC 9099D.

Exit interview conducted, a copy of this report and appeal rights provided.