Complaint Investigation Report

547203298-6-2-2026-24-AS-AWAN-DHGMLL-20250609094232

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

01/17/2025 and conducted by Evaluator Les Xiong

COMPLAINT CONTROL NUMBER: 24-AS-20250117084342

“This report is being amended to update the reporting manager.”

Staff do not ensure facility is free from pests.

Licensing Program Analyst (LPA) L. Xiong conducted complaint investigation visit to the facility.

During the course of this complaint investigation LPA interviewed staff on duty. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. The evidence from the investigation indicated there were roach observed in room 17 in the facility. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.”)