Complaint Investigation Report

547206600-9-24-2024-24-AS-SMOA-D9VSJH-20241009135508

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

06/12/2024 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20240612110524

WALNUT GROVE HOUSE, INC. DBA LEWIS GRAVES ARF #1

Staff did not notify CCL of relocation of residents in care.

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent complaint visit. LPA met with Administrator Tiffany Johnson and Tami Levyva and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department investigated the allegations listed above. Based on interviews conducted and records reviewed the facility did not report the incident in a timely manner.

The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted with Administrator, a copy of this report and appeal rights were provided.