Complaint Investigation Report

107209035-10-9-2025-24-AS-SMOA-DMMVPV-20251020163723

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

09/30/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250930093911

Due to lack of supervision, resident eloped

Staff did not follow emergency procedures for a fire

On 10/9/25 at 9:30 am 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) Michelle Ramos.

The Department conducted an interviews with facility staff. LPA toured the kitchen and dining room areas. LPA toured the back patio. Upon observation, LPA observed no burns in the kitchen and no puddles in the back patio area.

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 General Manager which confirms signature of this report.