Complaint Investigation Report

019200751-9-28-2023-15-AS-KHOS-CXBKPC-20231106070432

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

09/19/2023 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20230919081749

Staff does not ensure CCL Complaint Poster is posted in entryway of facility.

On 9/28/2023 at 9:25 AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Caregiver Wei Xie. Administrator Angel Kaung was called and was not able to come to the facility and agreed to have the caregiver sign off on the report.

During the initial 10-day complaint visit LPA observed that the Complaint Poster is not posted in an entryway or common area that is frequented. The poster they they do have is also not 20"x26" in size.

Based on LPAs observations, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.