Senior Care Records.

Complaint Investigation Report

Agnes House, Walnut Creek02/10/2023Licence 079201047

Census6
Date signed02/10/2023 06:57:28 PM
The inspector’s account

079201047-2-10-2023-15-AS-KHOS-CP2SPM-20230214130321

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

02/08/2023 and conducted by Evaluator James Sampair

COMPLAINT CONTROL NUMBER: 15-AS-20230208084824

Facility staff did not follow COVID-19 protocols.

On 02/10/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at 2:43PM to conduct a complaint investigation of the allegation above. The LPA met with Gladys Enriquez.

During the investigation, the LPA conducted interviews of 3 staff members and 2 witnesses.

Based on the interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED.

Two (2) citations were issued (refer to LIC 9099D).

Exit interview conducted and copy of this report provided via email.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction