Complaint Investigation Report

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

**A Civil Penalty in the total amount of $250.00 is being assessed for a repeat violation of Regulation 87465(a)(4) more than once in a 12-month period. Deficiency last cited on 05/29/2025. (See LIC421FC)**

Appeal rights were provided. See LIC9099D.

Exit interview conducted with Administrator, whose signature on form confirms receipt.