Complaint Investigation Report
Census5
Date signed11/06/2024 09:41:18 AM
079200624-11-6-2024-15-AS-KHOS-DBTQGW-20241210111013
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
10/18/2024 and conducted by Evaluator James Sampair
COMPLAINT CONTROL NUMBER: 15-AS-20241018145139
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction