Complaint Investigation Report

107209170-11-13-2025-24-AS-SMOA-DNLND4-20251120092142

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

11/07/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20251107163529

Staff did not communicate with responsible party regarding resident's care

On 11/13/25 at 5:30pm Licensing Program Analyst's (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator Eddiener Sison.

The Department conducted interviews 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 Administrator which confirms signature of this report.