Complaint Investigation Report

075601160-10-1-2021-15-AS-KHOS-C7QHS6-20211012062633

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

09/29/2021 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20210929100712

On 10/1/2021 at around 11:35 AM, Licensing Program Analyst (LPA) L. Ibo and RCEB Quality Assurance ( Q.A) Synthia Hakola conducted a joint visit at the facility to conduct investigation for the above allegation. LPA & QA met with Administrator Stewart Morris. LPA informed Administrator the purpose of the visit.

During the course of investigation, LPA obtained information, collected documents and interviewed staff and residents. According to Administrator the facility is not closing, based on LPA interview with a resident, R2 is moving out voluntarily. Two other residents moved out 10/1/2021 per Administrator. LPA observed during the visit that family of R5 & R6 moved out residents’ belongings.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted, copy of this report provided.