Complaint Investigation Report

157209068-10-10-2021-24-AS-MHON-C7XSTU-20211019141006

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

07/30/2021 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20210730144004

Carolyn Storruste, Residential Care Manager (RCM)

Facility is retaliating against resident.

On 10/06/21, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was met my Residential Care Manager (RCM) and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

During the course of the investigation, LPA conducted interviews and conducted record review of Resident R1's Eviction Letter, Appraisal and Needs Service Plan (LIC625) and a current Physician's report (LIC602a) signed and dated 07/07/21. Records revealed a change of condition from the time of R1's admission, which requires a higher level of care that the facility cannot provide at this time.

This agency has investigated the above allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. The allegation is UNSUBSTANTIATED.

An exit interview was conducted with Residential Care Manager and a copy of this report was provided via email. An electronic email read receipt confirms receiving these documents.