Complaint Investigation Report

079200575-9-25-2024-15-AS-KHOS-D9FRRJ-20240925131513

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

05/16/2023 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20230516162748

Facility did not have sufficient staff to meet the needs of the residents in care

Resident sustained multiple unwitnessed falls resulting in injury

Facility staff did not assist resident with activities of daily living in a timely manner

On 09/25/24 at 12PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit to amend the deficiency ( LIC 9099D) reports and remove the citations since the amended complaint allegations above were found to be unsubstantiated. LPA met with Director of Wellness (DOW) and explained the purpose of the visit.

During visit, LPA collected original complaint reports and re-delivered amended reports as unsubstantiated.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.