Complaint Investigation Report

079200965-2-18-2022-15-AS-KHOS-CKBQB8-20221018120108

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

02/14/2022 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20220214091428

Facility is not following COVID-19 guidelines during admission

Did not obtain admission document prior to admitting clients

On 02/18/2022 at 2:15 PM Licensing Program Analyst (LPA) L. Ibo arrived unannounced to in order to meet the 10-day requirement for the above allegations. LPA met with S2, staff on duty, LPA called Administrator Renee Tang, Administrator is not available during the visit, at around 2:50PM, staff Joy Bisaha arrived at the facility. LPA explained the purpose of the visit with Joy B.

LPA toured the facility with S2. LPA conducted interview and records review. LPA observed that there are no admission agreements, Covid19 test results prior to admission & physician’s assessment for C2 & C3.

Based on LPA information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D.

Exit interview conducted. A copy of this report and appeal rights provided.