Complaint Investigation Report

079200865-12-17-2021-15-AS-KHOS-CA4MU9-20211227085446

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

04/26/2021 and conducted by Evaluator Daisy Panlilio

COMPLAINT CONTROL NUMBER: 15-AS-20210426080728

On 12/17/21 at 1:30PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit to deliver the finding of above allegation. LPA explained the purpose of the visit with administrator.

Allegation: Resident is being illegally evicted

Based on interviews and record reviews, administrator sent a written 30 day notice of eviction to resident (R1) dated 04/09/21 which stated R1 is being evicted due to failure to submit the requested annual physician’s report, be examined by a doctor due to her medical & psychological condition requiring a higher level of care which the facility cannot provide. However, facts alleged in the notice fail to support any of the authorized reasons for termination of tenancy. Facility staff could not produce a written reappraisal report showing that R1 requires a higher level of care based on a current physician’s report.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due dates 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.