Complaint Investigation Report

157208767-4-22-2026-24-AS-SMOA-DTTN6Q-20260506101131

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

04/15/2026 and conducted by Evaluator Melinda Medina

COMPLAINT CONTROL NUMBER: 24-AS-20260415154451

Facility did not provide supervision allowing resident to walk the neighborhood freely

On 4/22/2026, Licensing Program Analyst (LPA) M. Medina arrived to conduct an unannounced initial 10-day complaint visit. LPA arrived, introduced self, stated purpose of visit, and allowed entrance to facility by staff. Licensee was not available to conduct today's complaint visit, LPA met with staff to conduct visit.

During the course of the investigation, documents were reviewed, interviews conducted and observations made. Based on information gathered during interviews, and review of video surveillance, R1 left facility unassisted by staff. The preponderance of evidence standard has been met, therefore the above allegation of is found to be SUBSTANTIATED.

A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 9099D. An immediate Civil Penalty is being Assessed on the attached LIC421M

Exit interview was conducted and a plan of correction developed and reviewed. A copy of this report provided to staff for facility records. .