Complaint Investigation Report

019200250-9-30-2022-15-AS-KHOS-CJVKTT-20221004081139

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

E BAY DELTA AC/SC , 1515 CLAY STREET, STE. 310

This is an official report of an unannounced visit/investigation of a complaint received in our office on

05/05/2022 and conducted by Evaluator Catherine Lin

COMPLAINT CONTROL NUMBER: 15-AS-20220505150257

Staff not address change in resident condition.

On 9/30/2022 at 10:10 AM, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct a subsequence complaint investigation visit in regard to the above allegation and delivered investigation findings. LPA met with staff and informed her the reason for visit. Administrator Juliana Taburaza arrived at a later time.

The Department has investigated this allegation and per records review and interviews, and found that C1’s particular health concern was addressed and indicated on the appraisal/needs and services plan dated on 11/18/2021 and 3/20/2022. Facility staff had documented it monthly.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiency cited, exit interview conducted with Administrator, and a copy of this report provided.