Complaint Investigation Report

157206907-6-11-2026-24-AS-SDOE-DW3NTF-20260717104441

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

10/24/2025 and conducted by Evaluator Daiquiri Boyd

COMPLAINT CONTROL NUMBER: 24-AS-20251024130046

Staff did not ensure that the facility was kept free of pests

Staff did not provide proper medication assistance to clients in care

Licensing Program Analyst (LPA) Daiquiri Boyd conducted the subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA toured faciltiy, interviewed staff on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegations are SUBSTANTIATED. A review of resident medication showed that a resident prescription was last administered on 5/31/26, has 4 refills left and has not yet been refilled. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 1), are being cited on the attached LIC 9099D.

LPA observed alive and dead bed bugs in 1 of the 4 rooms toured, as well as beetles and roaches in 4 of the 4 resident rooms toured. Altough this allegation is substantiated, a citation was not issued on this day due to citation CCR 80087(a)(1) being issued during the Annual Inspection on 6/9/2025.