Complaint Investigation Report

107206858-2-10-2025-24-AS-SMOA-DDTQK7-20250212111353

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

12/31/2024 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20241231112358

Staff did not ensure supervision was provided resulting in resident sustaining injuries while in care

Staff did not ensure reporting requirements were followed

On 2/10/25 at 1:00pm Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to deliver findings on above allegations. LPA met with Staff (S1) Liz Jugal and stated purpose of visit.

The Department reviewed records and conducted interviews.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued.

Exit interview conducted. A copy of this report was distributed to Staff which confirms signature of report.