Complaint Investigation Report

157208789-8-24-2021-24-AS-MHON-C67TE7-20210824143926

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

05/25/2021 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20210525160626

Facility accepted a resident without an admission agreement

On 06/02/2021, Licensing Program Analysts (LPA) L. Salazar and S. Doucette arrived to the facility unannounced to conduct the required 10 day inspection. LPAs conducted interviews with the reporting party and licensee. LPA requested to see the following documentation:

1.) Admission Agreement for Residents in care

2.) Pre-Admission Appraisal for residents in care

During the course of the investigation, LPAs toured the facility, conducted interviews and reviewed resident files for records maintained at the facility.

Based on interviews and observation of record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6, see LIC 9099D. Exit interview conducted and appeal rights given.