Complaint Investigation Report

015600118-1-31-2025-15-AS-KHOS-DFTRUP-20250417132016

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

01/27/2025 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20250127133155

On 1/31/2025 at 12:15PM, Licensing Program Analysts (LPAs) G. Luk and P. Manalo arrived unannounced to conduct a complaint investigation and deliver findings regarding the allegation above. LPAs met with Executive Director, Meghian Geul and informed her of the reason for the visit.

During the course of investigation, LPAs interviewed 2 residents, staff, witness, and complainant. LPAs reviewed and obtained documents including physician's report, care plan, and facility notes. Interview with staff and witness revealed that staff (S2) accompanied R1 to another resident's room. R1 was discovered missing by family member and facility staff was not aware.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.