Complaint Investigation Report

306001093-6-3-2026-22-AS-APAO-DUW7SZ-20260609215557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

ORANGE COUNTY RO , 770 THE CITY DR., SUITE 7100

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

05/21/2021 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 22-AS-20210521163331

Facility failed to provide medical attention

Licensing Program Analyst (LPA) Kesha Lewis made an unannounced complaint visit to deliver findings on the above allegations.

During the course of the investigation LPA conducted called reporting party (RP) and conducted an interview with LPA also attempted to contact the formor LPA to obtain any documents that had been requested. The facility no longer had documents because it was past the three (3) year requirment. The RP could not recall the insdent with any detail. Based on the information gathered during the investigation the department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the allegation the facility failed to provide medical attention this allegation is deemed unsubstantiated.

A copy of this report will be sent to the facility Via mail.