Complaint Investigation Report
011441040-2-14-2023-15-AS-KHOS-CP4N3A-20230216090601
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
05/28/2021 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20210528094622
Shirly Solomon, Assisted Living Supervisor
On 2/14/23 at 9:00AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver finding for the above allegations. LPA met with Shirly Solomon, Assisted Living Supervisor and explained the purpose of the visit.
Allegation - Resident was illegally evicted: During the course of investigation, LPA interviewed S1 on 6/7/21. S1 admitted that there was no written eviction notice to R1 or family member. Facility did not follow appropriate eviction procedures. Therefore, the allegation that resident was illegally evicted is substantiated.
Based on LPAs interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations of Health and Safety Code, is being cited on the attached LIC 9099D.
Exit interview conducted with Assisted Living Supervisor. Appeal Rights and a copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction