Senior Care Records.

Complaint Investigation Report

Scott Villa, Hayward06/05/2024Licence 019200750

Census34
Date signed06/05/2024 02:15:37 PM
The inspector’s account

019200750-6-5-2024-15-AS-KHOS-D6JRN4-20240624130943

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

05/31/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20240531102146

Staff not affording resident the personal right to leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night.

On 6/5/2024 at 1:05 PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Administrator Jonabelle Tolentino.

On the allegation of Staff not affording resident the personal right to leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. Based on record review and interviews the facility has a delayed egress door and alarms that go off when residents with dementia attempt to leave the facility. S1 states that if a residents does not have a diagnosis of Dementia they are able to come and go as they please. R1 does have a diagnosis of Dementia and documentation stating that R1 can not leave the facility unassisted

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction