Complaint Investigation Report

157204045-1-11-2022-24-AS-MHON-CBXM3V-20220224081547

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

10/15/2021 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20211015163924

Facility does not provide a safe environment for resident.

On 01/10/2022, Licensing Program Analysts (LPAs) L.Salazar and Shawna Doucette arrived at the facility unannounced to amend findings on the above allegation. LPA was greeted by Licensee, Marguerite Bruton. LPAs stated the purpose of the visit and was allowed entry into the facility by Licensee. LPAs had temperature taken upon entry to facility COVID precautionary questions were asked at the time of entry.

Based on interviews and observation of additional information, 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.

An exit interview was conducted with Licensee Marguerite Burton. A copy of this report and appeal rights were discussed and provided to licensee. A plan of correction was developed by licensee and reviewed with LPAs.