Complaint Investigation Report

075601547-9-13-2022-15-AS-KHOS-CJV4CA-20221003185848

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

09/12/2022 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20220912104729

On 09/13/22 at 10:30AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced complaint visit, met with staff (S1) and administrator (ADM). LPA explained the purpose of the visit with S1 and administrator.

During visit, LPA observed S1 wearing N95 face mask and face shield. LPA also observed 4 other staff wearing N95 face masks. S1 showed LPA sufficient supplies of PPEs (face shields, gowns, gloves, disposable shoe covers, N95 face masks, gloves) stored in the medication room cabinets. Local Public Health conducted a site visit on 08/30/22. ADM stated staff implemented LPH recommendations the same day to ensure mitigation of COVID infection at the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit Interview conducted and a copy of this report provided.