Complaint Investigation Report

079200856-5-6-2022-15-AS-HHUL-CEBURC-20220511154831

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

04/20/2021 and conducted by Evaluator Leslie Ibo

COMPLAINT CONTROL NUMBER: 15-AS-20210420162047

Xochit Munoz, Assistant Administrator;Kapioloni Singh, Direct care supervisor

Facility is not following infection control

On 5/6/2022 at 2:00PM, Licensing Program Analyst (LPA) L. Ibo conducted an unannounced complaint visit to delivered investigation finding. LPA met with staff Xochit Munoz, LPA explained the purpose of the visit. LPA called Administrator Athika Karolia , she stated that she is not available to meet with LPA, she gave permission to give copy of report to staff on duty.

Based on LPA’s observations, while LPA is touring the facility, staff does not properly wear mask, staff were wearing mask below their noses. LPA observed that staff are not wearing mask until LPA arrived at the facility.

The preponderance of evidence standard has been met; therefore, the above allegation(s) was found to be substantiated.Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.