Complaint Investigation Report

198603137-11-19-2021-28-AS-LHIS-C9NP6M-20211213100231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1000 CORPORATE CNTR DR. ST 500

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/16/2021 and conducted by Evaluator Cynthia D Chan

COMPLAINT CONTROL NUMBER: 28-AS-20211116152458

Resident missed scheduled optometrist appointments while in care.

Staff did not address a resident's change in medical condition.

Staff do not properly maintain a resident's room.

Staff speak inappropriately towards a resident while in care.

Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced complaint investigation regarding the allegations above. LPA met with Mae Nieva and explained the purpose of the visit. The Administrator was not present during the visit.

On today's visit, LPA interviewed the Staff and obtained the resident and staff rosters.

Based on interview and document reviewed, Resident #1 (R1) does not reside at this facility. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted. A copy of this report along with appeal rights were given to Staff.