Complaint Investigation Report

157209320-10-23-2023-24-AS-SPIY-CXMTZK-20231116141027

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

10/16/2023 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20231016144704

Unqualified staff providing care and supervision to residents.

Licensing Program Analyst (LPA) Shawna Doucette conducted a visit to commence a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Katie Blair.

LPA reviewed records and interviewed staff. During records review it was found S1 was working at the time of the visit and is not fingerprint cleared. S2 is not fingerprint cleared however S2 was removed from the schedule due to pending clearance and was not at the facility during visit.

Based on record review and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. Civil Penalties were issued.

An exit interview was conducted with Administrator Katie Blair and a copy of this report along with appeal rights and plan of correction were provided.