Complaint Investigation Report

071440014-3-9-2022-15-AS-KHOS-CCRRW2-20220322132224

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

03/01/2022 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20220301162236

On 3/9/2022, Licensing Program Analyst (LPA) L. Ibo conducted an unannounced complaint visit to conduct an investigation on the above allegation, LPA met with Mary Ann Leyba, Administrator and explained the purpose of the visit.

During the course of investigation, the Department obtained copies of resident roster and staff roster.

LPA conducted interviews. Based on interview conducted, C1 denied getting hurt from staff during a fall incident outside the facility, C1 stated that she like the staff and like living 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.

Exit Interview conducted and a copy of this report provided to Administrator.