Complaint Investigation Report

079200855-10-20-2022-15-AS-HHUL-CL222V-20221109160121

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

09/29/2022 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20220929093215

On 10/20/2022 at approximately 10:32 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit meeting with Stephanie Perez, Wellness Coordinator. The purpose of the visit was to deliver findings on the above allegation.

During the course of investigation, LPA obtained information, collected documents and interviewed staff. Staff stated that the memory care side of the facility was not being cleaned regularly due to lack of house keeping staff. 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.