Complaint Investigation Report

107209035-12-8-2025-24-AS-SMOA-DP9PFW-20251211101723

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

09/23/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20250923161009

Due to lack of supervision, resident passed away and staff were unaware

On 12/8/25 at 8:30 am Licensing Program Analyst (LPA) J. Leffall conducted a subsequent complaint visit to deliver findings on above allegation. LPA met with Administrator (A1) Brandon Ayala-Montelongo and stated purpose of visit.

Based on the interviews conducted and records reviewed, R1 was considered independent with no agreement between the resident and facility to provide care and supervision. R1’s cause of death was stated as natural. This agency has investigated the complaint allegations above. We have found that the complaint was unfounded. Exit interview was conducted.

Exit interviewed conducted. A copy of this report was provided to Administrator whose signature confirms receipt of the report.