Complaint Investigation Report

019200655-5-31-2023-15-AS-YFLS-CSLLNL-20230608085431

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

04/18/2023 and conducted by Evaluator Gregory Clark

COMPLAINT CONTROL NUMBER: 15-AS-20230418132909

On 5/31/23 at 1:40 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegations above. LPA met with Gina White, Care Staff and explained the purpose of the visit.

During the investigation LPA interviewed the reporting party (RP), 2 staff (S1 and S2), the licensee and R1’s mother. LPA also reviewed R1’s medication administration records.

Based on LPAs interviews and record reviews the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.