Complaint Investigation Report

197608595-4-4-2022-31-AS-NMAN-CFFT8F-20220616143016

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

02/01/2022 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20220201084111

Facility authorized hospice services for resident without resident's responsible party consent.

Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. Upon entry, LPA met with Co-Administrator, Herschel Weisman, and explained the reason for the visit.

---Facility authorized hospice services for resident without resident's responsible party consent.

It was alleged that other parties knew nothing about resident #1 (R1) receiving hospice care. To investigate these allegations, on 02/07/2022 at 10:30am, LPA requested pertinent documents and interviewed the Administrator and other parties. Based on interviews, the other parties were not aware that R1 started receiving hospice services. A record review also shows that the Administrator, Michelle Weisman, signed all hospice related documents in place of the resident's responsible party.

Based on the information revealed during the interviews and record review, the allegation is SUBSTANTIATED at this time. An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Administrator. A copy of this report, LIC 9099-D, and Appeal Rights were discussed and provided to Administrator, whose signature on this form confirm receipt of these documents.