Complaint Investigation Report

198602631-2-2-2023-28-AS-TVAO-CNTUQY-20230207144756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

GREATER LA AC/SC , 1000 CORPORATE CNTR DR. ST 500

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

01/26/2023 and conducted by Evaluator Elizabeth Irra

COMPLAINT CONTROL NUMBER: 28-AS-20230126120644

Rodrigo Celesios/S-1 and Toby Miclat (Administrator)

Staff are not following COVID-19 protocols.

Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial 10-day visit to investigate the above allegation. LPA was allowed entry by Rodrigo Celesios/S-1. Toby Miclat (Administrator) arrived at approximately 9:12 A.M.. LPA explained the purpose of today’s visit. The investigation consisted of the following: LPA interviewed S-1 and Facility Administrator and obtained a copy of the Staff and Resident Rosters.

Allegation: Staff not following COVID-19 protocols. During this investigation, upon entry LPA observed Staff #2 (S-2) not wearing a mask. LPA observed S-2 obtain an N-95 mask shortly after LPA's arrival, however, S-2, was not wearing the N-95 mask correctly as (1) mask strap was hanging under S-2's chin.

Based on observation, the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated. Health and Safety Code Title 22, Division 6 and Article 3 are being cited on the attached LIC 9099D. An exit Interview was conducted, appeal rights and a copy of this report was provided to Toby Miclat.