Complaint Investigation Report

075600819-12-6-2022-15-AS-KHOS-CMKNAQ-20221229091755

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

10/31/2022 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20221031085430

Staff spoke inappropriately to resident while in care

Staff did not adequately supervise resident in care resulting in resident’s head being covered by a blanket

Staff are not ensuring that documentation regarding residents in care are maintained accurately

On 12/06/2022 starting at 11:40 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to to deliver findings on the above allegation. LPA met with Leonora Maneja, Administrator and explained the purpose of the visit.

Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.