Senior Care Records.

Complaint Investigation Report

Acacia Creek - Union City, Union City06/28/2023Licence 015601302

Census147
Date signed06/28/2023 10:23:20 AM
The inspector’s account

015601302-6-28-2023-15-AS-KHOS-CTLRSG-20230710131644

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

06/21/2023 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20230621153006

Staff are mismanaging resident's medications.

On 06/27/2023 at approximately 9:35 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit meeting with Chuck Major, Administrator and explained the propose of the visit.

During the course of the investigation, LPA J. Clancy-Czuleger reviewed the staff and resident roster. A review of rosters reveals that the individuals involved in the incident do not work or reside at this facility therefore the above allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

No deficiency observed or cited during this visit. Exit interview conducted and a copy of this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction