Complaint Investigation Report

079200575-4-29-2022-15-AS-KHOS-CE5J4M-20220505064323

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

02/03/2021 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20210203144643

Micah Savage, Executive Director/Administrator

On 04/29/22 at 5PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent visit and met with administrator to deliver the findings of above allegations. LPA explained the purpose of the visit with administrator.

Allegation: Facility failed to meet residents needs

Based on interviews and record reviews, facility failed to meet the needs of the residents due to being short staffed. Residents, authorized representatives and staff expressed concerns regarding residents not being changed in a timely manner, not getting food or at all, getting residents up late, not receiving their scheduled showers and not getting medications on time. These issues were acknowledged by former ED due to short staffing. The preponderance of evidence has been met. Therefore, this allegation is substantiated.

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 via email.