Complaint Investigation Report

019200874-2-15-2023-15-AS-BFOG-CQ528U-20230320171051

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

06/24/2021 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20210624090925

On 2/15/23 at 10:00AM, Licensing Program Analyst (LPAs) K. Nguyen and L. Francisco arrived unannounced to deliver finding for the above allegation. LPA met with Stephane Hall Executive Director and explained the purpose of the visit.

Base of record reviewed of daily note LPA observed an incident that occurred on 6/19/21 were a staff was redirecting R1 from another resident room. It was noticed S6 accidently starched R1 hand while taking the phone from R1 hand. When staff observed the starched first aid was applied. No additional information forth coming from staffs.

Base one records reviewed, 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 provided to Executive Director.