Complaint Investigation Report

157204045-2-16-2022-24-AS-MHON-CF5LEA-20220606084105

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

01/10/2022 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20220110135143

Licensee does not have a fire clearance for bedridden resident.

Licensee does not have required facility postings

Licensee does not have staff associated to facility.

On 01/10/222, Licensing Program Analysts (LPAs) L.Salazar and Shawna Doucette arrived at the facility to conduct the required 10-day site inspection. LPA was greeted by Licensee, Marguerite Bruton. LPAs had temperature taken upon entry to facility but COVID precautionary questions were asked at the time of entry.

LPAs toured the facility, reviewed resident and staff files. The Physician's report (LIC602) for Resident R1 states "bedridden" status, facility is not fire cleared for bedridden. Required Personal Rights posting are not posted in the facility. Staff S1 was not associated to facility.

This department has investigated the above allegations. Based on the LPAs Observation the preponderance of evidence standard has been met; therefore, the above allegation(s) is/are found to be substantiated.

Deficiencies are being cited based on LPA's observation, interviews conducted, and record review in accordance with the CCR Title 22. See LIC 9099D. Civil Penalties were issued for a Fire clearance and Fingerprint clearance.

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.