Complaint Investigation Report

107209035-9-10-2025-24-AS-SMOA-DLKL6D-20250916082834

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

09/10/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250910092959

Staff do not ensure facility is kept in good repair

Licensing Program Analyst (LPA) J. Leffall conducted an unannounced facility visit to deliver findings on the allegation listed above. LPA met with facility facility Administrator Shelly Ramos, and stated the purpose of today's visit.

LPA observed a large spot of discoloration observed on the ceiling. A1 confirmed from the Vice President of Operations that the discoloration from the ceiling is caused from water damage. Based on observation, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficincies are being cited Per Title 22 Regulations.

Exit interview conducted. A copy of this report with appeal rights was distributed to Administrator which confirms the signature of receipt of this report.