Complaint Investigation Report

Allegation: Facility not maintained clean and sanitary

During visit, LPA along with ED toured the facility including but not limited to residents' bedrooms, bathrooms, kitchen area, dining and living room areas. LPA inspected residents' bedrooms and bathrooms Rms# 30, 32, 33, 46, 36. LPA observed fecal matter on resident's bath chair in Rm# 36, bathroom floors in Rms 31 & 46 (Jack & Jill bathroom) were observed with urine and fecal stains. The preponderance of evidence has been met. Thus, this allegation is subtantiated.

Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties .

Exit interview conducted. Appeal Rights and a copy of this report provided.