Complaint Investigation Report

107209035-12-18-2025-24-AS-SMOA-DPQMTM-20251226085344

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

12/12/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20251212093745

Facility staff did not safeguard resident's personal belongings.

On 12/18/25 at 9:00am Licensing Program Analyst's (LPA's) J. Leffall and M. Vega conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Administrator (A1) Brandon Ayala-Montelongo.

The Department conducted interviews with Administrator and staff. The Department requested the Safeguard for Property Valuables/Inventory form and facility did not posess document on R1's behalf.

Based on observation, record review 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 Licensee Representative which confirms signature of this report.