Complaint Investigation Report
The investigation consisted of the following:
On 04/30/2025, the department conducted a health and safety check of the residents in care and gathered client and staff records.
On 05/02/2025, the department provided the correct LIC9099 form to the facility. On 05/12/2025, the department interviewed Witness 1 (W1).
On 05/14/2025, the department interviewed W1.
On 05/16/2025, the department reviewed records and interviewed 3 staff. Interviews conducted consisted of Staff1 (S1) to Staff 3 (S3). The department reviewed Client 1’s (C1) records which consisted of their Physicians Report dated 12/12/2024; Admission Agreement dated 12/16/2024; Preplacement Appraisal Information dated 12/17/2024; Sample Body Check Form dated 12/17/2024; Hospice Notes for the Month of April 2025; Appraisal and Needs Services Plan dated 12/16/2024 and other pertinent documents.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction