Complaint Investigation Report

075601570-12-18-2024-15-AS-KHOS-DD5K4C-20250121063407

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

08/30/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20240830165258

Resident's hygiene needs are not being met

Facility is not following the resident's special diet

On 09/09/2024 at 09:05AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Administrator Steve Chou.

During the initial 10-day complaint visit. LPA interviewed staff, and collected the following documents resident (R1) admissions agreement, Physicians report, needs and services plan, Power of Attorney, and preplacment appraisal.

On the allegation Resident's hygiene needs are not being met. S3 stated that they bath R1 once a week. S3 explained that R1 does not like to use the hoyer lift and prefers bed baths while sitting.

On the allegation Facility is not following the resident's special diet, S1 stated that R1 is on a low sodium diet and is only served her soft foods.

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