Complaint Investigation Report

A deficiency is being issued in accordance with the Health and Safety Code and listed on the 9099D. The deficiency was also cleared because the licensee provided the required documents to the requesting entity.

An exit interview was conducted, and a copy of this report, Letter of Deficiency Cleared, and Licensee's Appeal Rights (9058 01/16) were provided to the Licensee, whose signature on this form confirms receipt of these documents.