Complaint Investigation Report

247206921-11-20-2025-24-AS-SMOA-DNQLZG-20251124081156

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

08/21/2025 and conducted by Evaluator Vadim Gorban

COMPLAINT CONTROL NUMBER: 24-AS-20250821102719

Staff do not provide adequate supervision resulting in resident falling on multiple occasions.

On 11/20/2025, Licensing Program Analyst (LPA) V Gorban conducted subsequent complaint inspection. LPA met with administrator. The purpose of this visit is to deliver the findings of the investigation completed by the Department.

During the visit, LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.

Allegation: Staff do not provide adequate supervision resulting in resident falling on multiple occasions. Based on records reviews resident fall recorded on multiple occasions with no re -appraisal follow up. The department conducted interviews and reviewed records. LPA discussed with Administrator the significance of completing pre-appraisal and needs and services plan for residents in timely manner. Re-appraisal and new needs and services is to be completed upon resident’s change of condition.

Deficiency will be cited according to Title 22 regulation on attached LIC9099-D

Exit interview conducted, report signed and copy of this report with appeal rights provided to administrator.