Complaint Investigation Report

015601262-3-11-2022-15-AS-HHUL-CM4TME-20221214135058

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

03/08/2022 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20220308145636

Facility is not following COVID-19 protocols.

On 3/11/2022 at 1:00PM, 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, Diosdado De Luna and informed him reason for the visit.

During the course of investigation, LPA interviewed 2 staff and reviewed COVID-19 screen documents (visitor's log, temperature log). Upon entry, staff did not conduct COVID-19 screening for LPA. Interview with staff indicated that staff did not check visitor's vaccination status prior to visit.

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 LIC 9099D. Exit interview conducted. A copy of this report and appeal rights provided.