Complaint Investigation Report

019200735-12-30-2021-15-AS-KHOS-CAEPES-20220106101538

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

02/22/2021 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20210222092730

Insufficient staff to meet residents needs

On 12/30/21 at 4:30PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit to deliver the findings of above allegation. LPA explained the purpose of the visit with administrator.

Allegation: Insufficient staff to meet residents needs

Based on interviews and observations by Licensing Program Analyst (LPA) A. O’Hollaren on 03/03/21, LPA observed 4 caregivers and one administrator assisting 4 residents at the facility during visit. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.