Complaint Investigation Report

157200963-4-29-2025-24-AS-SMOA-DH3TGT-20250527144338

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

03/06/2025 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20250306124021

Facility staff do not ensure that clients are accorded privacy when using the restroom.

On 4/29/2025 Licensing Program Analyst (LPA) M. Garza arrived to complete a complaint visit. LPA met with Administrator, John Noriega, explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility and a health and safety check on clients in care.

During visit on 3/7/2025 facility was toured, copies of LIC 500 (Personnel Record), LIC 9020 (Register of Facility Clients/Residents), employee contact information and pictures were taken. During todays visit LPA completed a tour of the facility,gathered documentation (resident roster, staff schedule, configuation list, identification for staff, job descriptions and reviewed resident and staff files, took pictures and completed interviews. During visit (3/7/2025) it was observed restoom stall door in building A (men's) did not properly lock. The preponderance of evidence standard has been met per Titile 22 and the allegation listed above is SUBSTANTIATED. Deficiency cited per Title 22 on 9099D.

Exit interview completed with Administrator, John. A copy of this report, deficiency and appeal rights provided.