Complaint Investigation Report

247209172-3-5-2026-24-AS-AWAN-DVRTUT-20260707150253

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

02/05/2026 and conducted by Evaluator Brianna Miranda

COMPLAINT CONTROL NUMBER: 24-AS-20260205081606

Staff do not follow reporting requirements

On March 5, 2026 Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to deliver finding for the allegations listed above. LPA met with Interim Executive Director Natalie Levario and Administrator Elizabeth Reynaga.

The Department has investigated the allegation of: Staff do not follow reporting requirements. LPA conducted multiple interviews. During the interviews it was stated R2 had fallen and an incident report was not provided to the Dept regarding the resident's fall.

Based on the Departments interviews & records review the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 7, is being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report LIC9099, LIC9099D, and appeal rights were provided to Administrator Elizabeth Reynaga.