Complaint Investigation Report

015601284-12-3-2021-15-AS-KHOS-C9VKBA-20211220064512

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1515 CLAY STREET, STE. 310

This is an official report of an unannounced visit/investigation of a complaint received in our office on

12/01/2021 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20211201162014

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a 10-day complaint visit. LPA met with Carmen Portillo-Diaz, care staff. LPA requested to call Nalini Bhutani, administrator. Nalini arrived after about 10 minutes. LPA informed the purpose of visit.

LPA obtained copy of LIC9020 Register of Facility Residents which showed resident (R1) not on the list. LPA verified, and Carmen Portillo-Diaz and Nalini Bhutani stated R1 does not live in this facility. Therefore, the complaint is close as unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted and copy of this report provided to Nalini Bhutani.