Complaint Investigation Report

Follow up interview with licensee revealed I1 ceased working 10/16/2025 and obtained different employment. There was sufficient information obtained that supported a violation had occurred.

Based on interviews and record/document reviews obtained during the investigation the allegation Uncleared staff member providing care and supervision to residents in care is Substantiated, meaning the preponderance of evidence standard has been met, therefore the above allegation is Substantiated .

**$500.00 civil penalty assessed for uncleared adult I1 working in facility

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.