Complaint Investigation Report

157209257-1-15-2025-24-AS-KHOS-DD5Q5Y-20250121105244

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

12/13/2024 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20241213083504

Administrator Pamela Bradley and Memory Care Director Mikayla Goulart

Staff neglected resident resulting in resident developing pressure injuries.

Staff does not ensure resident's diapering needs were being met.

Staff did not seek medical attention to resident in a timely manner.

On 01/15/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to delivered complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with Administrator Pamela Bradley and Memory Care Director Mikayla Goulart .

During the course of the investigation, records were received, interviews were conducted, and facility was toured. Interviews conducted with residents who confirms staff provided care for residents. Staff changes resident’s brief when needed. Based on records review and interviews conducted, there was insufficient evidence to prove or disprove that staff did not seek medical attention to resident in a timely matter. Therefore, preponderance of evidence standard has not been met, therefore, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to the Administrator, whose signature on this form confirms receipt of this report.