Complaint Investigation Report

107208943-6-5-2025-24-AS-SMOA-DHKL4P-20250612082552

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

06/03/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250603132231

On 6/5/25 at 2:30 pm Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegation. LPA met with Administrator Camalah Kopacz.

The Department conducted an interviews with facility staff Administrator and resident. R1 stated likes living at facility and does not have any issues with staff.

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 Adminsitrator which confirms signature of this report.