Complaint Investigation Report

107209492-3-24-2025-24-AS-KHOS-DFBGDS-20250401051538

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

03/18/2025 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20250318164041

Staff allows resident to smoke while oxygen tank(s) are in use.

Staff allows resident to have access to a lighter.

On 03/24/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation. LPA introduced self, stated the purpose of the visit, and met with Administrator Karen Dhaliwal. LPA deliver complaint findings on the above allegations.

During the course of the investigation, the Department conducted interviews, toured the facility, and reviewed records. Resident was observed requesting for cigarette from staff and staff lighting cigarette for resident outside. The department observed resident smoking outside in designated area. Disposed medications are disposed by medication technicians and management staff into a pharmaceutical container.

Based on interviews conducted, observations, and records reviewed, preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator, whose signature on this form confirms receipt of this report.