Complaint Investigation Report
019200956-3-29-2022-15-AS-KHOS-CJ2LYH-20220907091024
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
08/18/2021 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20210818144450
On 3/29/2022, Licensing Program Analysts (LPAs) L.Ibo and C. Lin arrived unannounced to deliver complaint findings for the allegation above. LPAs met with Ami Champaneri co-founder.
During the investigation, LPAs interviewed staff and residents. Staff and residents stated that one staff (S6) does not wear a mask all the time while working.
The preponderance of evidence has been met. Therefore, the staff are not wearing mask is substantiated.
Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.
Exit interview conducted, copy or the report and appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction