Complaint Investigation Report

Regarding the allegation that Facility did not give proper notification of eviction, the following has been concluded: On October 10, 2025, facility administrator Faith Rasouli sent an email to the responsible party and attorney-in-fact for former facility resident R1 with the intention to notify the responsible party that R1's assessed care needs were no longer compatible with the care and supervision levels provided at the facility. However, upon review of the message, it was determined that the notice did not include the following elements as required by Section 87224 of the California Code of Regulation on Eviction Procedures:

- A copy of the resident’s current service plan.

- The right of the resident or resident’s legal representative to contact the department to investigate the reasons given for the eviction pursuant to Section 1569.35.

- The contact information for the local long-term care ombudsman, including address and telephone number.

As a result, the allegation is determined to be Substantiated, meaning that the preponderance of evidence standards has been met. A type B deficiency is cited on an attached form LIC9099-D.

Administrator Faith Rasouli had to leave the premises before the conclusion of the visit and authorized caregiving staff Johnny Bugtong to sign the report on her behalf. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.