Complaint Investigation Report

277209241-12-5-2024-24-AS-KHOS-DBULBN-20241211073700

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

11/26/2024 and conducted by Evaluator Vadim Gorban

COMPLAINT CONTROL NUMBER: 24-AS-20241126141511

Facility did not adhere to resident's Admission Agreement.

Licensee is not ensuring that facility is free from mold.

Staff did not accord dignity to resident in care.

On 12/04/2024, Licensing Program Analyst (LPA) V. Gorban conducted an unannounced follow up complaint visit. LPA explained the purpose of visit to Administrator Jessica Sanchez. LPA toured the facility conducting safety checks, reviewed and received copies of facility records.

Allegations: Facility did not adhere to resident's Admission Agreement. Licensee is not ensuring that facility is free from mold. Facility is in disrepair. Staff did not accord dignity to resident in care.

During complaint investigation department reviewed facility files and interview administrator. Based on information provided the resident (R1) is not under Licensing supervision and jurisdiction. Based on these findings, the department have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted, report signed and copy of this report provided to Administrator for facility records.