Complaint Investigation Report

198601051-5-22-2024-28-AS-FFIS-D5L239-20240524170159

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

MONTEREY PARK ASC , 1000 CORPORATE CNTR DR. ST 500

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

07/14/2023 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20230714145916

Facility failed to submit an incident report to the proper agencies

Licensing Program Analyst (LPA) Sanjay Vaid conducted a subsequent complaint visit regarding the allegations and discuss the findings of the complaint investigation. LPA Vaid met with Concepcion Pacina -lead staff and Marilyn Acabal- administrator to discuss the purpose of the visit, which was to deliver complaint investigation findings.

The investigation consisted of the following: On 07/18/2023 LPA Tao toured the facility, conducted physical plant tour of the facility, and obtained a client and staff roster, file for client #1 for review.

On 07/18/2023 the department conducted interviews with Assistant Administrator -Marilyn Acabal and lead staff – Concepcion Pacania. On 07/18/2024 the department conducted interview with client #1 (C1).