Complaint Investigation Report

415601039-4-8-2025-14-AS-KHOS-DFTMCR-20250417092958

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BRUNO RO , 851 TRAEGER AVE., SUITE 360

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

01/31/2025 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 14-AS-20250131115024

- Staff are not communicating with resident's POA in a timely manner

On 04/08/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to open the complaint and investigate the allegations received. LPA met with interim administrator Davina Barker and explained the purpose of today's visit.

During the course of the investigation, LPA conducted interviews and reviewed documentation regarding the resident and the allegations. In regards to overcharging resident in care, it appeared to be an error in the billing system. The facility worked with the family to correct the mistake and compensate the family accordingly. In regards to no communicating with the resident's POA in a timely manner, LPA could not confirm if there was an issue regarding communication in a timely manner based on interviews and documentation observed. These allegations are unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. This report is reviewed with Davina and a copy is provided during today's visit