Complaint Investigation Report

015601083-4-4-2022-15-AS-KHOS-CMKNPM-20221229093833

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

03/28/2022 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20220328085840

On 4/4/2022 at 12:25PM, 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 Executive Director, Dolly Rizvi and informed her the reason for visit.

During the course of investigation, LPA interviewed 7 residents, 1 staff and 2 witnesses. LPA reviewed and obtained 3 resident files including physician's report and care plan. Interview with residents and witnesses indicated that residents were getting enough food to eat and 3 meals are being provided each day. LPA observed staff serving dinner to residents which included pasta, vegetable, and soup.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted. A copy of this report provided.