Complaint Investigation Report

019200418-2-20-2025-15-AS-YFLS-DE8QXE-20250225113325

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

11/06/2024 and conducted by Evaluator Luisa Fontanilla

COMPLAINT CONTROL NUMBER: 15-AS-20241106160249

Insufficient staff based on the Client’s needs and services.

On 2/20/2025 at around 12:25 pm, Licensing Program Analyst (LPA) L. Fontanilla arrived unannounced to deliver finding of the above allegation. LPA met with staff May Angelica Ignacio and explained the purpose of the visit. LIcensee/Administrator Shirley Bordon was informed about the visit.

During the course of the investigation, the department obtained and reviewed the following documents: LIC 500, IPPs, DSP training for all staff, and Physician’s Reports and conducted interviews.

Allegation: Insufficient staff based on the Client’s needs and services

LPAs interviewed staff and reviewed records. All interviews and record reviews conducted indicate that there is no night shift. One client has seizure and had at least 2 episodes that occurred around 1am-2am in the bathroom. 2 of the 3 clients wake up at night, walk around and would look for food and eat. 2 of 3 clients are incontinent.

Based on the Lic 500 submitted to CCL, there is no awake staff assigned from 10 pm till 6am to supervise clients or change diapers of incontinent clients.

Based on interviews and record reviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be Substantiated. CCR Title 22 is cited on the attached LIC9099D.

Exit interview was conducted and Appeal Rights was provided.