Complaint Investigation Report

079201257-8-13-2024-15-AS-KHOS-D97MDN-20240917093126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

This is an official report of an unannounced visit/investigation of a complaint received in our office on

07/23/2024 and conducted by Evaluator Alona Gomez

COMPLAINT CONTROL NUMBER: 15-AS-20240723151436

On 8/01/2024 at 12:00 a.m., Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with Administrator, Maria Arceo and explained the purpose of the visit. Census is 6. Administrator was unavailable to resign and Caregiver, Rommel Dimzon signed report.

During the visit LPA obtained copies of the physicians reports/orders for R1, and R2. LPA also toured the facility and observed dryer in disrepair with out of order sign. Staff currently dries clothes outside on line. LPA received photos of R1 improperly restrained in bed with a red white and blue strap that was tied on bed bars.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.