Complaint Investigation Report

019200702-9-3-2025-15-AS-BFOG-DLCTTK-20250909150053

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

08/26/2025 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20250826153953

Staff are using a restraint on a resident

On September 3, 2025, at approximately 9:25 a.m., LPAs K. Nguyen and P. Manalo arrived to conduct an unannounced complaint investigation. LPAs met with Administrator (ADM) Nalini Nath, explaining the purpose of their visit.

It was allegeded that Staff are using a restraint on a resident. LPAs investigated with the Reporting Party (RP). On the same day, LPAs initiated an initial investigation, obtained records for Resident 1 (R1), and interviewed the hospice nurse, Administrator, and two caregivers. Based on an interview with a hospice nurse and a recorded review, it shows that R1 has a doctor's order for a soft belt to prevent R1 from falling out of the wheelchair. LPAs verified the order from R1's hospice binder, including, but not limited to, LIC 602.

Based on interviews conducted and records reviewed, the above allegation is unsubstantiated. The preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated.

An exit interview is conducted and a copy of this report is provided.