Complaint Investigation Report
079201175-7-12-2023-15-AS-KHOS-CU3TUC-20230725150207
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
07/07/2023 and conducted by Evaluator Jill Clancy-Czuleger
COMPLAINT CONTROL NUMBER: 15-AS-20230707171459
Resident sustained unexplained bruising while in care
On 07/12/2023 at 09:04 AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct an initial 10-day complaint visit. LPA met with Administrator Whitney Ward explained the purpose of the visit.
During the initial 10-day complaint visit. LPA interviewed staff, they stated that R1 was admitted to the facility on 06/27/2023 and on 06/28/2023 staff noticed brusing on her right hand. They informed the administrator who noticed it was an old bruse and assumed the family was aware of it and did not inform them.
Based on LPA’s interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 has been cited.
The Facility was cited, and citations can be found on the LIC 9099-D. Exit interview conducted. Appeal Rights and a copy of this report provided. Exit interview conducted.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction