Complaint Investigation Report

547203298-6-2-2026-24-AS-AWAN-DNERY2-20251114122537

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

08/29/2025 and conducted by Evaluator Les Xiong

COMPLAINT CONTROL NUMBER: 24-AS-20250829085606

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

Staff does not ensure facility is kept free of pests

Staff speaks inappropriately to residents in care

Staff does not ensure residents personal property is safely secured

On 10/30/2025, Licensing Program Analyst (LPA) L. Xiong arrived unannounced to deliver findings on the above allegations. LPA introduced self, stated the purpose of the visit and met with the Licensee.

During the course of the investigation, LPA reviewed records, conducted a facility tour and interviewed residents and staff.

It was determined that the above allegations: Staff does not ensure facility is kept free of pests, Staff speaks inappropriately to residents in care and Staff does not ensure residents personal property is safely secured are SUBSTANTIATED.

The evidence from the investigation indicated that the facility has a roach and bed bug infestation. Although the facility is receiving pest control services, the service selected is not sufficient as the Licensee has pest control “only spray a few rooms”. Based on interviews conducted, it was found that the Licensee told R1 “that she would give R1 $2000, if R1 leaves” while Licensee presented an eviction notice to R1. Interviews with Administrator revealed that facility staff recently “deep cleaned” and disposed of items belonging to previous residents that resided at the facility. Licensee stated that current resident clothing was not disposed of unless the residents placed a trash bag in the hallway. However, upon review of records, it was discovered that the Licensee did not maintain accurate records of resident’s personal belongings.

Deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D.

Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to the Licensee. Report was signed on-site.