Complaint Investigation Report
107206822-8-25-2022-24-AS-SMOA-CJVKA9-20221004074335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2022 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20220819112351
On 8/25/22 Licensing Program Analyst (LPA) M. Garza arrived at faciilty to complete an unannounced initial 10 day visit. LPA introduced self, was COVID pre-screened and was permitted into facility. Administrator, Marilen Gonzales was contacted and arrived some time later. LPA toured facility inside and out. A Health and Safety check was completed on residents in care. Residents observed visiting family outside and in common area.
During visit LPA requested documentation, completed interviews and reviewed 7 staff files. LPA observed 5 of 7 staff files do not have the required training.
The allegation listed above is SUBSTANTIATED. Deficiencies on LIC 9099D. Exit interview completed. A copy of this report and appeal rights given.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction