Complaint Investigation Report

015600538-3-16-2022-15-AS-KHOS-CCRVNE-20220322163501

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

01/08/2021 and conducted by Evaluator James Sampair

COMPLAINT CONTROL NUMBER: 15-AS-20210108124558

1. Client was not provided assistance while in care

2. Client was not properly fed while in care

3. Client does not receive medication while in care:

On 03/16/2022 at 1:00 PM, Licensing Program Analyst (LPA) James Sampair conducted a complaint visit. Upon entering the facility, LPA explained that the purpose of the visit was to investigate this complaint. During the visit, LPA checked records, conducted interviews, and delivered the findings.

Based on the review of the records and interviews of staff and residents, the Department found that the allegations were UNSUBSTANTIATED, meaning that the allegations may have happened or are valid, but there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted. A copy of this report and a copy of the Appeal Rights were provided.