Complaint Investigation Report

015601095-12-18-2023-15-AS-HHUL-CZMQPK-20240119112053

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

12/14/2023 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20231214155404

Staff physically abused resident at the facility

On 12/18/2023 at 10:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings regarding the allegation above. LPA met with General Manager, Michael Fillari and informed him of the reason for the visit.

During the course of investigation, LPA interviewed resident, staff, and witness. LPA obtained and reviewed documents including physician's report, care plan, and POA documents. Interview with resident and witness revealed the caregiver that hit R1 was from an outside agency and was not a facility caregiver. W1 stated that the caregiver was hired by R1's POA and is a private caregiver for R1 only. The Department will cross report to appropriate agency.

This agency has investigated the complaint allegation. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report provided.