Complaint Investigation Report

079201116-7-20-2023-15-AS-KHOS-CWGJAM-20231010065259

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

04/17/2023 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20230417090235

Staff do not ensure resident's special dietary needs are being met

On 7/20/2023 at 4:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Executive Director, Jennifer Coons and explained the purpose of the visit.

During the course of investigation, LPA interviewed 4 residents, 1 staff, 3 witnesses, and complainant. LPA reviewed and obtained documents (facility menu, physician's report, care plan, special diet orders, and hospice documents). After reviewing the facility's menu, facility does not have gluten free options such as gluten free breads and pastas. R1 has a doctor's order for gluten and lactose free diet. However, S1 stated that facility is unable to accommodate all diets.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.