Complaint Investigation Report

079200380-3-2-2022-15-AS-HHUL-CKZW5U-20221109155944

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

02/24/2022 and conducted by Evaluator Lizette Francisco

COMPLAINT CONTROL NUMBER: 15-AS-20220224160544

On 3/2/2022 starting at 10:55 AM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct a complaint investigation for the above allegation. LPA met with Registered Nurse, Magdala D'Autruche and explained the purpose of the visit. Administrator, Obed D'Autruche later arrived at 11:20 AM.

During the complaint investigation, LPA toured facility, reviewed records and interviewed staff. It is alleged Licensee failed to issue proper refund. Based on record review, resident (R1) was admitted to the facility on 2/14/22 and R1 passed away at the hospital on 2/21/2022. R1's belongings were removed from facility on 2/27/2022, therefore, facility is still within the 15 day period to issue a refund to R1's responsible party.

This agency has investigated the complaint alleging Licensee failed to issue proper refund. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report provided.