Complaint Investigation Report

019201025-7-21-2023-15-AS-KHOS-CVKLYD-20230911091011

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

02/18/2022 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20220218093018

Untrained staff providing care to residents

On 7/21/2023 at 11:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Administrator, Divine Fernandez and explained the purpose of the visit.

During the course of investigation, LPA interviewed complainant. LPA reviewed and obtained documents (staff initial training, CPR, First Aid, medication training, and dementia training). After reviewing a sample of staff training, LPA observed majority of the staff did not have required annual training completed in 2021 and part of 2022.

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.