Complaint Investigation Report

157209373-2-28-2024-24-AS-SMOA-D2WMZB-20240229090249

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

01/04/2024 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20240104103038

Facility is not providing a healthful environment for residents in care.

On 02/12/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to delivered complaint findings on the above allegation. LPA introduced self, stated the purpose of the visit and met with Tasha Duncan. Administrator Kala Gibson was called and unable to attend meeting.

During the course of the investigation, the Department conducted interviews and toured the facility. LPA observed mold in the resident’s bathroom shower floor and wall. Based on observation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 6 is being cited on the attached Lic 9099D. An exit interview was conducted. A copy of this report and appeal rights was provided to staff, whose signature confirms receipt of this report.