Complaint Investigation Report

306005910-10-7-2024-22-AS-AORZ-D9XV2Y-20241011160356

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 770 THE CITY DR., SUITE 7100

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

07/13/2021 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20210713124144

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to continue the investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

During the course of the investigation, LPA toured the facility and interviewed staff. Regarding the allegation that facility is in disrepair, the investigation revealed the following: During the tour of facility, LPA observed three spots where the flooring is missing or has detached from the floor. There is one spot in the entry, one in the hall and one in a resident room. The remainder of the facility physical plant appears clean, safe and sanitary. Based on observation, the preponderance of evidence standard has been met. Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights.