Complaint Investigation Report

079201175-12-13-2023-15-AS-HHUL-D2EVE8-20240213152153

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

09/25/2023 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20230925151651

Resident sustained unexplained bruising while in care.

On 12/13/2023 at approximately 9:25 am Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit. LPA met with caregiver Cydel Caplo and explained the purpose of the visit. Administrator Matt Ward was called and designated Cydel Caplo to sign off on the report.

During the course of investigation, LPA obtained information, collected documents and interviewed staff and residents. It was documented in Resident 1 (R1) physicians report that R1 was on medication that caused her to bruise easily.

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.