Complaint Investigation Report

019200735-6-7-2024-15-AS-BFOG-D6TMQD-20240703094835

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

05/31/2024 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20240531085551

Staff did not ensure that a resident's care needs were met

On this day around 9:25am Licensing Program Analysts (LPAs) K. Nguyen and A. Gharachorloo arrived to conduct visit on the above allegation. LPAs met with administrator (AD), Joseph Gapasin and discussed the reason for visit.

Allegation: Staff did not ensure that a resident's care needs were met- Substantiate

During investigation LPAs interviewed administrator, reviewed client files, and facility home chore list for the month of May. Facility administrator confirmed that the above allegation is true, due to R1 vomit was not being clean during the time it happened. AD indicated that the staff did not being responsible and left R1, but there where another staff that was present with R1.

The investigation alleging staff did not ensure that a resident’s care needs were met. We have found that the complaint is SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

Exit interview is conducted and a copy of this report is provided via email including the LIC 9099D. An appeal rights is provided via email.