Complaint Investigation Report

075600194-8-30-2022-15-AS-KHOS-CHTKWK-20220831081606

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

06/11/2021 and conducted by Evaluator Lizette Francisco

COMPLAINT CONTROL NUMBER: 15-AS-20210611114701

Facility's exit alarm on doors is not functioning properly.

***THIS IS AN AMENDED REPORT FROM VISIT ON 6/18/2021***

On 6/18/2021 starting at 8:50am, Licensing Program Analysts (LPAs) L. Francisco and C.Fowler arrived unannounced to conduct complaint investigation for the above allegation. Upon arrival LPAs were greeted by front desk. Executive Director, Tracey Ingleman later arrived at 9:15am.

Based on record review and interview with staff (S1), resident (R1) left facility and exited through one of the exit doors facing the main parking lot on June 9, 2021. Once staff were made aware of resident's whereabouts, staff determined exit door had malfunctioned and was not operating correctly.

Based on LPAs interview which were conducted 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. Appeal Rights and a copy of this report provided.