Complaint Investigation Report

079201088-3-7-2023-15-AS-HHUL-CPZM2B-20230317091316

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

02/16/2023 and conducted by Evaluator James Sampair

COMPLAINT CONTROL NUMBER: 15-AS-20230216170240

Facility staff did not refund resident's authorized representative upon the death of the resident in a timely manner.

At 9:00 AM on 03/07/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to deliver findings for the above allegation. LPA met with Administrator (ADM) Consultant Telesha Clarke to explain the reason for the visit.

During the investigation, LPA interviewed Ms. Clarke who, after speaking with Licensee, was unable to supply records of a refund having been sent to complainant.

Based on the data collected over the course of the investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED.

Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

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