Complaint Investigation Report

198601716-6-19-2024-28-AS-DSIS-D9UVTS-20241008164334

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

GREATER LA AC/SC , 1000 CORPORATE CNTR DR. ST 500

This is an official report of an unannounced visit/investigation of a complaint received in our office on

06/18/2024 and conducted by Evaluator Erik Zaragoza

COMPLAINT CONTROL NUMBER: 28-AS-20240618110757

Licensing Program Analsyts (LPAs) Erik Zaragoza conducted an unannounced initial complaint visit in regards to the allegation listed above. LPA explained the purpose of the visit to Sami Abdulsemiu, caregiver for the facility, and was granted entrance. Administrator Gilbert Cardenas was informed of the visit by phone call.

The investigation consisted of the following: LPAs Erik Zaragoza conducted a tour of the facility and interviewed Clients #1 - 4 (C1 - C4), Staff #1 - 3 (S1 - S3). LPA also request that administrator Gilbert Cardenas email LPA the Physician's Report, Appraisal, and FACE Sheet from Client #1 (C1), along with the current staff and client rosters.

Due to insufficient information available at this time, the above allegations needs further investigation.

Exit interview conducted with Sami Abdulsemiu, and a copy of this report was provided.