Complaint Investigation Report

019201143-9-16-2024-15-AS-KHOS-D9MNLR-20241001103358

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

09/11/2024 and conducted by Evaluator Lisha Holmes

COMPLAINT CONTROL NUMBER: 15-AS-20240911142042

Douglas Blake, Interim-Executive Director

Staff did not prevent a resident from eloping.

Staff do not distribute residents' medications as prescribed.

On 09/16/2024 around 01:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an initial 10-day complaint visit and closed the complaint for the above allegations. LPA met with Douglas Blake, Interim-Executive Director (ED) and explained the purpose of the visit.

Staff did not prevent a resident from eloping.

Staff do not distribute residents' medications as prescribed.

Deficiencies were cited on a Case Management LIC809D and Complaint #15-AS-20240830161136 LIC

Exit interview conducted. A copy of this report and appeal rights were provided to ED.