Complaint Investigation Report

107209492-1-12-2026-24-AS-SMOA-DQWNSV-20260202094342

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

01/07/2026 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20260107172854

On this date 01/12/26, Licensing Program Analyst (LPA) M. Yang conducted initial complaint investigation. LPA introduce self, stated the purpose of the visit, and met with Administrator Karen Dhaliwal. LPA discussed complaint and delivered complaint findings to Administrator.

During the course of the investigation, the department conducted interviews, records were reviewed, and the facility was toured. Based on interviews conducted and records reviewed, R1's current physician report documents that the resident cannot leave the facility unsupervised. Interviews confirmed R1 had left the facility premises with R2 without staff supervision on 01/06/26, therefore, the preponderance of evidence has been met, the above allegation is found to be SUBSTANTIATED. An exit interview was conducted. A copy of this report and appeal rights was provided to Administrator, whose signature on this form confirms receipt of this report.