Complaint Investigation Report

150404353-10-3-2024-24-AS-SMOA-D9XKRQ-20241011080818

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

09/30/2024 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20240930100339

Staff did not ensure adequate care and supervision was provided to client resulting in client being left unattended

On 10/03/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an initial complaint vist. LPA introduce self, stated the purpose of the visit, and met with Administrator Maryann Hagstrom who granted LPA entry into the facility.

During the course of the investigation, interview were conducted, and records were reviewed. On 08/26/24, C1 was left unattended at local store. On 09/27/24, C1 was left unattended by staff at a park.

Based on interview conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. An exit interview was conducted, and a copy of this report and appeal rights was provided to Administrator, whose signature confirms received of this report.