Complaint Investigation Report

019200973-2-24-2023-15-AS-KHOS-CPPMP4-20230307084632

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

03/02/2022 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20220302144356

On 2/24/2023 at 2:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to deliver findings in regards to the allegation above. LPA met with Manager, Rachell Paniagua.

During the course of investigation, LPA interviewed 2 staff, 1 witness, and complainant. LPA obtained and reviewed documents including staff schedule, dementia plan, physician's report, pre-placement appraisal, emergency information, care plan, personal rights, and incident report. Interview with staff revealed that R1 was last seen by staff was at 6:45PM. An hour later, the facility was informed that R1 AWOL and was found at R1's home. Facility did not have a wander guard system available.

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.