Complaint Investigation Report

157202482-8-29-2024-24-AS-SPIY-D8ZKMR-20240911080156

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

05/20/2024 and conducted by Evaluator Melinda Medina

COMPLAINT CONTROL NUMBER: 24-AS-20240520090943

Facility staff are not properly addressing pest infestation in facility

Facility staff does not ensure that residents oxygen equipment is operable

Facility staff are unable to communicate with residents and responsible parties

On 8/29/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced subsequent complaint visit to deliver findings. LPA introduced self and stated purpose of visit and allowed entrance by caregiver. Administrator contacted by telephone and arrived a short time later to meet with LPA regarding complaint findings.

During course of the investigation, LPA toured facility, reviewed records, and conducted interviews. This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED.

No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records