Complaint Investigation Report

312701038-3-10-2022-25-AS-KHOS-CCTJYG-20220324072755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 520 COHASSET RD., STE. 170

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

11/05/2021 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 25-AS-20211105063835

Licensing Program Analyst (LPA) Kerry Hiratsuka arrived at the facility unannounced on 03/10/2022 to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility.

LPA investigation the allegation "Illegal Eviction.” LPA interviewed Licensees, former resident's responsible party, and a third party. Licensee did request permission to issue a 3 day eviction notice from Community Care Licensing Division that was not granted and LPA confirmed that it was not issued. Licensee was also in the process of writing a 30 day eviction notice that was not issued. The allegation is dealing whether a verbal eviction notice was given or not. Licensee stated she thinks a third party told the responsible party there is an eviction notice given. Other interviews stated there was an eviction notice given. LPA cannot prove or disproveif a verbal eviction was issued based on the different version of events. Allegation is unsubstantiated.