Complaint Investigation Report

157209363-9-9-2025-24-AS-SMOA-DLTMRH-20250924095021

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

09/08/2025 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20250908131535

Staff do not provide adequate food service

Staff mishandled the residents medications

On 09/09/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct initial complaint investigation. LPA introduced self, stated the purpose of the visit and met caregiver Rizaline Osuna and Liza Fortun. Staff called Licensee/ Administrator Leticia Jackson who arrived later during investigation.

During the course of the investigation, interviews were conducted, records were reviewed, and facility was toured. Adequate nonperishable and perishable food were observed and provided. Destructive medications are recorded, stored and locked in kitchen cabinet.

Based on interviews conducted, observation, and records reviewed, therefore the preponderance evidence 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.