Complaint Investigation Report

547200844-12-30-2025-24-AS-SMOA-DPXLF7-20260102074240

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

12/17/2025 and conducted by Evaluator Jacques Leffall

COMPLAINT CONTROL NUMBER: 24-AS-20251217153636

Staff is disclosing personal information regarding the residents

Staff is not properly reporting incidents involving the residents

On 12/30/25 at 9:00 am Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on above allegations. LPA met with Resident Care Director (RCD) Britney Polman.

The Department conducted an interviews with facility staff.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued.

Exit interview conducted. A copy of this report was distributed to Resident Care Director which confirms signature of this report.