Complaint Investigation Report

019200685-12-12-2022-15-AS-KHOS-CNLKBU-20230131064606

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

12/05/2022 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20221205100853

Staff did not complete an initial inventory of resident's personal property

On 12/12/22 Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a complaint investigation for the above allegation starting at 3:00pm. LPA met with Parveen Singh Senior Executive Director and explained the purpose of the visit.

During visit LPA interviewed Senior Executive Director, and reviewed Former Resident's (R1) admission agreement, physician report, progress notes, and review resident personal property and valuables (LIC 621) agreement.

During the course of the investigation, it was revealed that staff did not mismanaged resident’s medication and is following doctor order when they have confirmation.

During the course of the investigation, it was revealed that resident’s responsible party sign and stated that they are declining to track any personal property of resident.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report and appeal rights provided.