Complaint Investigation Report

157204045-6-3-2022-24-AS-MHON-CF5LE9-20220606084104

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

On 05/06222, Licensing Program Analysts (LPAs) L.Salazar and Alexandria Walton arrived at the facility to deliver findings on the above allegations. LPAs were greeted by Licensee, Marguerite Bruton, stated the purpose of visit and we allowed entry. COVID precautionary measures were taken at the time of entry.

During the investigation, LPA reviewed resident and staff files, which were found to be incomplete. without the required LIC forms. Based on the LPAs observations the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated.

Deficiencies are being cited based on CCR Title 22. See LIC 9099D. A plan of correction was developed. Plan of correction was provided by licensee and reviewed with LPA.

An exit interview was conducted with Licensee Marguerite Burton. A copy of this report and appeal rights were discussed and provided to licensee.