Complaint Investigation Report

198603504-9-11-2025-28-AS-RORN-DEVLSU-20250318090118

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1000 CORPORATE CNTR DR. ST 500

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

08/29/2024 and conducted by Evaluator Noemi Galarza

COMPLAINT CONTROL NUMBER: 28-AS-20240829114254

Staff handled resident in a rough manner resulting in an injury.

Staff did not prevent a resident from falling out of a window.

***This amended report 9/11/2025 supersedes the report dated 3/14/2024 in reference to citation 87411(a). The citation is dismissed. On 3/14/2025 & 3/11/2025, Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visits to deliver findings on the above allegations. The purpose of the visit was discussed telephonically with Executive Director Beatriz Lui. Alyssa Morales met with LPA.

The investigation consisted of: On 9/6/24, LPA reviewed medications/medication administration records, and conducted a physical plant tour that included inspection of 17 resident rooms, kitchen, common areas, and Memory Care Unit. During subsequent visits Memory Care Unit, common areas, and random resident residents were inspected. A total of 7 staff (S1-S7) and 8 residents (R4- R11) were interviewed. Residenst (R1 & R3) moved out and were not interviewed and R2 is cognitively impaired. Former staff (S8 - S11) were not interviewed. Resident files were reviewed and relevant documents were obtained[Medication Administration Records (MARs) & pest control service invoices]. While the incident and resulting injuries are not disputed to have occurred, there is insufficient evidence to prove the resident required additional supervision. Exit interview was conducted with Business Office Manager Alyssa Morales. A copy of the report was provided.