Complaint Investigation Report

Allegation: Licensee does not ensure there is a qualified Administrator present

Based on interviews with RP, LPA's record review of Personnel Report (LIC500) dated 10/08/21 and facility site visits on 03/30/23, 05/18/23 and 05/23/23, ADM was not present during the hours stated on the LIC500. LPA requested ADM to provide a current LIC500 on 03/30/23 & 05/18/13; to date on 05/23/23 the LIC500 was not provided, designated staff was not present, and LIC308 was last dated 11/01/21.

The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D.

Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties.

Exit interview conducted. A copy of appeal rights and this report provided to Rosa Mayorga, Care Staff.