Complaint Investigation Report

079200601-12-14-2022-15-AS-KHOS-CMKNE3-20221229092317

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

12/06/2022 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20221206134406

Facility staff yelled and screamed at resident.

On 12/14/2022 starting at 09:10 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct complaint investigation for the above allegation. LPA met with RN Ritchie Villapando and explained the purpose of the visit. Executive Director, Desiree Huflar joined later.

During the course of investigation, LPA obtained information, collected documents and interviewed 2 staff. Based on interview with staff (S1, S2), it was revealed that the incident did occur where a staff member was yelling in the presence of a resident.

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.