Complaint Investigation Report

100400043-1-31-2023-24-AS-SMOA-CNULPW-20230208075634

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

12/14/2022 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20221214161734

On 1/28/2023 Licensing Program Analyst (LPA) M. Garza arrived at facility for an unannounced complaint visit to deliver findings. LPA met by receptionist. Administrator was contacted but unavailable. LPA was given permission to meet with Director of Nursing (DON), Sam Parvinder. LPA was COVID pre-screened at entry. LPA completed a Health and Safety check on residents in care. Residents observed in hallway and in rooms at time of visit.

During investigation LPA requested and reviewed documentation (resident roster, staff roster and contact information, visitor log for one month, house rules and a copy of daily schedule for residents). LPA observed a sign on the door with visiting hours (10-4) and “must call to schedule appointment”. Interviews conducted with staff support the allegation. The allegation listed above has met the preponderance of evidence standard per Title 22 and is found to be SUBSTANTIATED.

Deficiencies cited on 9099D. Exit interview completed with DON, Sam. A copy of this report and appeal rights given.