Complaint Investigation Report

107209545-6-3-2025-24-AS-SPIY-DMBN8T-20251010101453

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

05/28/2025 and conducted by Evaluator Katie Brown

COMPLAINT CONTROL NUMBER: 24-AS-20250528130643

Facility is violating residents personal rights.

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial complaint investigation. LPA met with and explained the reason for the visit and the discussed the allegation with Administrator (AD) Mary Ann Alfonso.

During the visit, LPA conducted interviews and record review. On 5/27/25, Resident (R1) requested AD call 911. When AD left the room for the phone, R1 locked the door, not allowing AD to observe or report on R1's condition to dispatch as R1 had been displaying self injerous behavior. Interviews also reveal conflicting reports that a male caregiver told R1 to keep the door unlocked. Based on interview and record review the above allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

There were no citations issued. An exit interview was conducted and a copy of this report was left with AD