Complaint Investigation Report

107208837-11-13-2025-24-AS-SMOA-DNLNCF-20251120092037

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

11/06/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20251106163018

Facility is not meeting resident's dietary needs.

Facility is not meeting resident's hygiene needs.

Facility staff is not answering the facility phone.

On 11/13/25 at 1:00pm Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator (A1) Camalah Kopacz.

The Department conducted interviews with staff, residents and reviewed facility and resident records.

Although the allegations 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 Ann Marie Bushay which confirms signature of this report.