Complaint Investigation Report

107208889-8-15-2022-24-AS-MHON-CJ2MZZ-20220907100359

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

07/14/2022 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20220714142748

Assistant Administrator Elisa Pua, Caregiver Rufinita “Net” Deocampo and caregiver Bienvel "Ben" Yep

On 08/15/2022, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a subsequent complaint inspection and deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with caregiver Rufinita “Neth” Deocampo and caregiver Bienvel "Ben" Yep. Administrator Arlene Bautista was called and Assistant Administrator Elisa Pua arrived shortly.

During the course of the investigation, LPA reviewed records and interviews were conducted which confirmed staff are not meeting resident’s needs upon request, specifically relating to assisting resident out of bed.

Based on records reviewed and interviews conducted, 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 are being cited on the attached LIC 9099D. An exit interview was conducted, and a Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights was provided to Assistant Administrator.