Complaint Investigation Report

126803830-8-30-2023-21-AS-BMOS-CW8TP2-20231002145337

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

07/06/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230706140520

At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigaiton into the above allegations. LPA met with Executive Director Charmin Bailey, toured the facility, reviewed records and conducted interviews. LPA reviewed resident care plans and Hospice documentation and found several residents requiring two person assists. LPA reviewed staffing schedules and found certain shifts that did not have proper staffing to meet resident needs. LPA observed memory care only had 1 staff scheduled on certain days. Based on the Departments investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Charmin Bailey and Appeal rights were given.