Complaint Investigation Report

547203298-6-2-2026-24-AS-LXIG-DUNTBZ-20260602143559

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

06/18/2025 and conducted by Evaluator Les Xiong

COMPLAINT CONTROL NUMBER: 24-AS-20250618114755

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

Staff do not ensure that bathrooms have towels

Staff do not ensure resident has clean bedding

Staff do not provide adequate food service

This is an amended report. Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation to the facility. During the course of this investigation, LPA reviewed facility files relevant to the complaint and conducted a facility tour.

It was determined that the above allegations: Staff do not ensure that bathrooms have towels, Staff do not ensure resident has clean bedding, and Staff do not provide adequate food service are SUBSTANTIATED.

The evidence from the investigation indicated the facility did not have a sufficient supply of linen to provide to 24 residents. Licensee did not ensure clean linen were in use by residents at all times. Towels were observed to have holes and discoloration. Resident bedding was observed to dirty and damaged with holes exposing the comforter’s inner filling. Facility staff did not provide the residents with clean bedding when requested.

Evidence from the investigation revealed that the facility is not properly storing food and was not providing food that is in good quality to the residents in care.

Deficiencies are being issued in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D. Exit interview conducted and a plan of correction was developed with the Licensee. A copy of this report and appeal rights were discussed and provided to the Licensee, whose signature on this form confirms receipt of this document.