Complaint Investigation Report
247206921-3-13-2025-24-AS-KHOS-DFJHBL-20250408060317
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
03/10/2025 and conducted by Evaluator Vadim Gorban
COMPLAINT CONTROL NUMBER: 24-AS-20250310162656
Facility staff did not provide resident reappraisal upon change in condition
On 03/12/2025, Licensing Program Analyst (LPA) V Gorban unannounced visited facility stated above to commence a complaint investigation, stated the purpose of the visit and was allowed entry into the facility by Administrator (AD) Lisa .
Allegation: Facility staff did not provide resident reappraisal upon change in condition. During this visit LPA toured the facility performing safety checks, also LPA interviewed Administrator, facility staff and resident. Based on interviews and observation R1 did not receive updated documents of re -appraisal due change the level of care, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D
Exit interview conducted and copy of this report provided to Administrator for facility records.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction