Complaint Investigation Report

331880716-6-21-2023-56-AS-EMAN-DHXSNG-20250624140129

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1650 SPRUCE ST STE 200 MS29-27

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

10/31/2022 and conducted by Evaluator Amy Goldenberg

COMPLAINT CONTROL NUMBER: 56-AS-20221031141433

Licensee designee does not have qualifications adequate to be responsible and accountable for management of the facility.

This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to further investigate the above-mentioned complaint allegation. Investigation included review of the facility file. Investigation revealed the following information: Na Zhao is the designee on file. LPA has determined based on Licensee Na Zhao being unavailable to be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility that the listed alleged violation is valid. We have substantiated the complaint allegation as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D.