Complaint Investigation Report

197609117-11-29-2021-31-AS-JAPL-C9D39J-20211203170309

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

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

07/03/2018 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 31-AS-20180703114242

Facility staff failed to provide proper care and supervision to Resident #1 (R1) which resulted in R1’s death.

Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced subsequent complaint visit to the above facility. The LPA met with Executive Director Taylor Giunto and explained the reason for the visit.

On 01/31/2019, the Department issued findings of Substantiated for the above allegation. The licensee was cited for violating California Code of Regulations (CCR) Title 22, 87464(f)(1) Basic Services, in which “Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2.” An immediate civil penalty of $500 was also issued. An appeal was issued by the licensee, and the deficiency was dismissed. After further review, the Department has determined that the allegation, “Facility staff failed to provide proper care and supervision to Resident #1 (R1) which resulted in R1’s death” will be changed from Substantiated to Unsubstantiated. The $500 penalty will be dismissed. Although the Department is no longer substantiating the above allegation, the Department found that facility staff failed to provide proper care and supervision to Resident #1 (R1), which resulted in serious bodily injury and will be addressed in a Case Management visit. Exit interview conducted. A copy of the report was issued.