Complaint Investigation Report

075601160-3-6-2025-15-AS-KHOS-DFAN82-20250331101337

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

02/25/2025 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20250225102154

Licensee is not ensuring that the facility has adequate amount of food

Facility staff are not serving nutritious meals

Facility staff speak inappropriately to residents in care

On 03/06/2025 at 09:00AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger and Y. Brown arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Caregiver Dennis Ambat. Administrator Stew Morris was informed of the visit.

During the initial 10-day complaint visit LPAs toured the facility and interviewed staff, and residents. LPAs observed two refrigerators with minimal food in them. The produce that was observed in the kitchen was three lemons and two bags of lettuces. S2 stated that shopping is done every two weeks. In interviews with residents LPAs found that S1 frequently yells and curses in fromt of and at residents.

Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.