Complaint Investigation Report

019200664-6-20-2024-15-AS-KHOS-D6JRH8-20240624130155

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

06/17/2024 and conducted by Evaluator Alicia Delmundo

COMPLAINT CONTROL NUMBER: 15-AS-20240617080839

Licensee did not keep resident's (PR) personal information confidential.

At 12:05 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to investigate the above allegation. LPA met with Adeliza Magallones, administrator, and informed the reason for visit. LPA spoke over the phone with John Ronald Olivarez, licensee.

During investigation, LPA obtained copy of LIC9020 Register of Facility Clients/Residents. LPA interviewed licensee who stated he did not disclose the name of prospective resident (PR) but disclosed the health information to prospective room mate (R1) and R1''s family member, but PR was never admitted to the facility. LPA also interviewed the administrator who stated that PR was not admitted to the facility. Review of LIC9020 showed PR is not listed.

Based on information obtained and FR is not admitted to the facility, the allegation is unsubstantiated.

No deficiency cited. Exit interview conducted and copy of this report provided.