Complaint Investigation Report

197609758-5-12-2022-31-AS-RRAZ-CKGRZH-20221023132755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

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

01/12/2022 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20220112143232

At approximately 5:30 p.m. on 05/12/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with Administrator and disclosed the reason for the visit.

Regarding the allegation “Resident was unkempt”, it was alleged Resident #1 (R1) was in poor condition due to being unchanged. To investigate the allegation, LPA conducted a physical plant tour and interviews. At approximately 12:15 p.m. LPA observed R1 in their room. R1 was sitting in a wheelchair and in good condition. LPA conducted interviews with complainant on 01/12/2022 at 4:08 p.m. and with facility staff on 01/20/2022 at 12:40 p.m. Based on interviews, there is not sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Copy of report provided.