Complaint Investigation Report

079200813-1-13-2023-15-AS-KHOS-CNLLXZ-20230131080933

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

06/15/2022 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20220615160447

On 01/13/2023 starting at 01:02 pm, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Amabelle Amparo, Administrator and explained the purpose of the visit.

During the course of investigation, LPA obtained information, collected documents and interviewed staff and residents. Based off intrviews and records reviews, LPA confirmed that R1 had made threataning coments to S1. S1 in fear made a call to the police to assist in the situation and they removed the resident for the facility to midigate the situation.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.