complaint·November 17, 2025

INVESTIGATION REVEALED THE FOLLOWING: ALLEGATION #1: Staff did not provide resident with personal care supplies. ALLEGATION #2: Staff did not safeguard resident's mail. The complaint alleges that the staff failed to provide Resident #1 (R1) with personal care supplies and did not protect (R1's) mail. Reports indicate that incontinence care supplies intended for (R1) were delivered to the facility, but a staff member withheld them for several days without providing any explanation for the delay. Additionally, a staff member retrieved and opened (R1's) incoming mail and stole its contents. No further information about this situation has been provided. On November 17, 2025, between 09:30 AM and 10:25 AM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) of the three (3) staff members were unable to confirm the accusations. (S1-S3) stated that (R1) has not experienced any issues with receiving, tampering with, or mishandling mail or packages at the facility. According to (S1), on November 12, 2025, at around 4:00 PM, (S1) reported that three large boxes of personal supplies arrived for (R1) in the front lobby. (S1) noted that two care staff were busy helping residents, and the maintenance staff had finished their shift. (S1) informed (R1) about the delivery but mentioned there was no one available to take the packages to (R1's) room at that time. The packages were stored securely overnight in a secure storage room and scheduled for delivery the next day. (S1) claimed that on the following day, the care staff got busy and forgot to ask maintenance to deliver the packages to (R1). (R1) received packages as soon as it was discovered that they were still in the storage area. Staff members (S1-S4) reported that (R1) regularly receives monthly incontinence supplies and personal mail, all delivered on time. They stated that no staff member has tampered with, withheld, or stolen any resident's mail or packages. (S1 and S4) explained that USPS delivers mail around midday. The office staff sorts it, and it is usually sent to residents during lunch or dinner times. If a resident is not present during meals, the mail is taken to their room the same day. On November 17, 2025, between 10:00 AM and 10:20 AM, the Department interviewed a resident identified as Resident #1 (R1). (R1) explained that (R1) panicked with anxiety when the packages were not delivered on time. (R1) recalled being informed that the packages would be stored in a secure area, but (S1) never provided a reason for the delivery delay. Despite the confusion, (R1) believes it was a misunderstanding resulting from poor communication. (Evaluation Report continues LIC 9099-C) (R1) confirmed receipt of boxes of personal supplies and stated that (R1) did not believe the delivery delay was intentional or intended to cause discomfort. (R1) mentioned that issues with USPS mail, including tampering and theft, had occurred several years ago. (R1) stated that the incident happened with a former employee and did not want to go into detailed information about that incident. (R1) noted that it had never happened again. (R1) also expressed a positive opinion about the current staff at the facility, stating they are good and honest, and feel safe and secure as a resident in care at this facility. (R1) said to have not encountered any further issues with mail or package delivery since. On November 17, 2025, between 10:30 AM and 11:40 AM, the Department conducted interviews with resident members, identified as Resident #2 through Resident #9 (R2-R9). Eight (8) of the eight (8) resident members are unable to corroborate these claims. (R2-R9) reported no issues with package or USPS mail delivery at the facility, stating that all deliveries arrived on time. They also indicated that they had never experienced any personal items being tampered with, lost, or stolen through mail or freight delivery. Furthermore, all residents expressed their satisfaction with the services provided by the staff. The Department reviewed (R1’s) Identification and Emergency Information LIC 601 (dated 02/07/21), Medical Assessment for Residential Care Facilities for the Elderly LIC 624A (06/24/25), Preplacement Appraisal Information LIC 603 (dated 08/20/18), Resident Personal Property and Valuables LIC 621 (dated 08/20/18) and Personal Rights Residential Care Facilities for the Elderly LIC 613C (dated 08/20/18). Further review of Physicians Order Medications (dated 11/17/25) revealed (R1) is prescribed 29 medications and 20 of them present side effects that include: headache, dizziness, restlessness, anxiety or confusion (ref: National Institute of Health). During the investigation on November 17, 2025, the Department inspected (R1’s) room and verified the receipt of personal items. The Department observed staff members interacting with residents and noted that their conduct was appropriate. The Department found that the facility upholds the rights of its residents. Posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster were displayed prominently throughout the facility. Based on the information gathered from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated . An exit interview was conducted with Jenni Gordon and copies were provided.