Complaint Investigation Report

079200801-12-15-2022-15-AS-KHOS-CQYNVW-20230417104838

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

12/09/2022 and conducted by Evaluator Carol Fowler

COMPLAINT CONTROL NUMBER: 15-AS-20221209135142

Insufficient staffing to meet residents' needs

On 12/15/2022 at 9:40PM, Licensing Program Analysts (LPAs) C. Fowler an L. Hall arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings for the allegations above. LPA met with Residents Service Director, Jerrick Hall and explained the reason for visit.

During the investigation, LPAs interviewed Staff 1 (S1) and obtained the following documents, staff roster, facility roster, and November staffing schedule. S1 stated during interview the facility was short staffed in the month of November. During record review LPAs observed that on11/24/2022 there were three (3) staff scheuled for the day but only 2 were working at the same time Staff 2 (S2) and Staff 3 (S3).

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

Exit interview conducted. A copy of this report and appeal rights provided