Complaint Investigation Report

157208767-5-18-2026-24-AS-SMOA-DUPNJ5-20260603102946

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

05/17/2026 and conducted by Evaluator Melinda Medina

COMPLAINT CONTROL NUMBER: 24-AS-20260517122302

Staff did not accept resident back from hospital

On 5/18/2026, 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 spoke with Licensee via telephone to advise of complaint and conduct interview.

During the course of the investigation, interviews were conducted. Based on information gathered during interviews, R1 was ready for discharge from hospital on 5/15/2026 and was not accepted back at facility. Per licensee, they can no longer meet resident's needs. 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.

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