Complaint Investigation Report

157209304-12-18-2025-24-AS-AWAN-DQJTQV-20260121135634

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

12/11/2025 and conducted by Evaluator Jimmy Duarte

COMPLAINT CONTROL NUMBER: 24-AS-20251211122424

Staff did not report incident to responsible party

Licensing Program Analysts (LPA) J. Duarte and L. Xiong conducted an unnounced complaint investigation visit to the facility. During the course of this complaint investigation LPAs interviewed staff on duty and residents. LPAs obtained and reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. The evidence from the investigation indicated that a report was not generated and sent to licensing for an incident that occurred on 11/18/25. Based on LPAs observations and interviews which were conducted and reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D.”