Complaint Investigation Report

107209492-9-12-2025-24-AS-SMOA-DLTMQ5-20250924094806

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

07/15/2025 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20250715135159

Resident sustained severe pressure injuries due to staff neglect

Staff are not providing adequate food service to residents

Staff are not providing residents authorized representative with resident's documents

Staff are not ensuring the facility is clean

On 09/12/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to delivered complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit, and met with Administrator Karen Dhaliwal.

During the course of the investigation, the department conducted interviews, received copies of records, and toured the facility. Based on interviews conducted, records reviewed, and observations, R1 is received hospice care for pressure injury. Staff assist in feeding food for residents that requires feeding. Facility provided requested documents to resident’s authorized representative. Facility was observed inside and outside. Facility was observed to be cleaned and free of odor. Therefore, the preponderance of evidence standard has not been met, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of this report.