Complaint Investigation Report

157209397-7-1-2025-24-AS-SMOA-DJCMLL-20250707094231

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

06/13/2025 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20250613155013

Staff did not ensure adequate supervision was provided resulting in resident sustaining an injury while in care

Staff did not ensure resident was spoken to in an appropriate manner

Staff did not ensure resident received medical attention in a timely manner

On 07/01/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced subsequent complaint investigation and deliver findings on the above allegations. LPA introduce self, stated the purpose of the visit, and met with Licensee/ Administrator Jethronel Lazaga.

The Department conducted interviews, reviewed records, and toured the facility. Records and interviews confirms two staff were working when alleged staff did not ensure adequate supervision resulting in resident sustaining an injury while in care. Staff provided first aid to R1 when observed with a scratch on resident head. Based on interviews conducted, there was insufficient evidence to prove or disprove that staff did not ensure resident was spoken to in an appropriate manner. Therefore, the preponderance of evidence standard has been met; therefore the above allegations are found to be UNSUBSTANTIATED. Exit Interview conducted. A copy of this report was provided to Licensee.