Complaint Investigation Report

547200844-12-2-2025-24-AS-SMOA-DP3VUJ-20251205154448

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

11/16/2025 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20251116222344

Staff are not keeping resident information/records confidential

On 12/02/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint visit to deliver complaint findings on the above allegation. LPA introduced self, stated the purpose of the visit and met with Resident Care Director Brittney Polman.

During the course of the investigation, facility was toured and interviews were conducted. Based on interviews conducted, residents’ information is provided to outside medi-cal assisted agencies programs for referral to verify if the resident meets the programs requirements prior to the resident applying for the medi-cal assisted programs without resident’s knowledge. Residents are unaware of the programs until the outside agencies meet with the residents after the referral has been accepted for the initial enrollment process. Therefore, the allegation alleging staff are not keeping resident information/records confidential, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Exit interview was conducted. A copy of this report and appeal rights was provided to Resident Care Director Brittney Polman, whose signature on this form confirms receipt of this report.