Complaint Investigation Report

547209005-8-16-2023-24-AS-MHON-CVELSJ-20230906090049

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

08/09/2023 and conducted by Evaluator Malia Thao

COMPLAINT CONTROL NUMBER: 24-AS-20230809155515

Facility staff did not meet resident's needs resulting in injury.

On 8/15/23 at 1:52 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an initial 10-day complaint inspection. LPA explained reason for inspection and was granted entry by staff. Licensee/Administrator (LIC) Eesaeng Martinez arrived a short time later.

LPA reviewed records, made observations, and conducted interviews. Based on records reviewed, observations, and interviews conducted, there was not sufficient evidence to show the facility staff did not meet the resident's needs resulting in injury. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the above allegation is unsubstantiated.

Exit interview was conducted. A copy of this report was given to Licensee, whose signature confirms receipt of this report.