Facility Evaluation Report

Licensing Program Analyst, [LPA] Hiratsuka, arrived on September 26, 2025, for an unannounced inspection to follow up on a substantiated complaint investigation. LPA met with Licensee Manpreet Dyal and explained the purpose of the visit.

On November 15, 2023, the Department concluded a complaint investigation regarding the following allegations: Resident sustained severe pressure injury due to staff neglect, facility failed to seek medical attention, and staff left resident in soiled diaper for an extended period.

The licensee was cited for the following: California Code of Regulations (CCR), Title 22, § 87466 Observation of the Resident, CCR, Title 22, § 87411(a) Personnel Requirements, and CCR, Title 22, § 87468.1(a)(2) Personal Rights of Residents in All Facilities.

At the time of the complaint visit on November 15, 2023, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code § 1569.49.

The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section § 15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility not providing proper care, supervision, and delaying timely medical care, resulting in the deterioration of pressure injuries leading to hospitalization with wound infection, requiring pain control and two wound debridement surgeries.