Complaint Investigation Report

079200734-4-12-2023-15-AS-KHOS-CQYRTJ-20230417131825

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

11/10/2021 and conducted by Evaluator Lisha Holmes

COMPLAINT CONTROL NUMBER: 15-AS-20211110151724

Facility failed to properly assess resident prior to rate increase

On 04/12/23 at 11:45 AM, Licensing Program Analyst (LPA) L. Holmes amended allegation and met with Gloria Amaya, Care Staff. On 03/30/23 at 12:00 PM, Licensing Program Analyst LPA arrived unannounced to deliver findings for the above allegation. LPA met with Administrator (ADM), Rose Onyeagocha and explained the purpose of the visit.

During the course of the investigation, LPA L. Francisco obtained information, collected documents, reviewed records, interviewed staff and resident. It was alleged facility failed to reassess resident prior to rate increase. Based on record review, LPA observed an email notifying R1’s responsible party of a rate increase in care. LPA L. Francisco observed the last appraisal was completed on April 24, 2020 and not signed by R1’s authorized representative.

Based on LPAs observations and interviews 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), is being cited on the attached LIC 9099D. Exit interview conducted. Appeal rights and a copy of this report provided to ADM.