Complaint Investigation Report

015601302-6-18-2025-15-AS-YFLS-DHWPRW-20250623113321

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

05/16/2025 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20250516101416

Viarmina Paje-Forsythe (Mina), Wellness Manager

Staff are keeping resident against their will.

*****THIS IS AN AMENDED REPORT FROM VISIT 05/22/2025*****

On 05/22/2025 at around 10:00 am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a complaint visit. LPA met with Wellness Manager, Viarmina Paje-Forsythe (Mina), and explained the purpose of the visit. LPA received via text from Executive Director Sandra Simon, for Mina to sign the report.

Allegation: Staff are keeping resident against their will - UNFOUNDED

During the course of the investigation, LPA K. Nguyen reviewed the resident roster from 2017- May 22, 2025. LPA conducted an interview with S1, S1 stated R1 never resided at the facility. A review of rosters reveals that the individuals involved in the incident are not residing at this facility; therefore, the above allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiency observed or cited during this visit. An exit interview was conducted, and a copy of this report was provided.