Complaint Investigation Report

019200737-4-13-2023-15-AS-KHOS-CRLQ2J-20230507114712

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

03/03/2022 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20220303154626

Facility staff treats resident in a mean and harsh way

On 4/13/2023 at 2:00PM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to deliver findings of the complaint investigation for the above allegation. LPA met with Administrator, Joseph Gapasin and explained the purpose of the visit.

Based on information obtained. During records review, on March 11, 2022, LPA discovered that staff (S1) was terminated from the facility due to verbally and emotionally threatens client in care. There was no injury on the client and no hospitalization noted.

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. Appeal Rights and a copy of this report provided.