Complaint Investigation Report

157209257-3-7-2023-24-AS-SMOA-CPX22F-20230314170037

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

02/17/2023 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20230217121216

Administrator/ Executive Director Pamela Bradley

Facility did not follow resident's admission agreement.

On 3/6/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator/ Executive Director Pamela Bradley.

During the course of the investigation record were reviewed and interview were conducted. Admission agreement was not updated to reflect the hours of one-on-one that the resident needed. The total charges that the facility was providing the responsible party did not agree nor sign to the charges. In additional there is no updated physician report or assessment that the resident needed a 24 hour one-on-one care.

Based on record reviewed and interview conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Under California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. Plan of correction was discussed. An exit interview was conducted, and a copy of this report and appeal rights was provided to via email to Administrator.