Complaint Investigation Report

191221839-9-3-2021-28-AS-CYEE-C723EC-20210919181053

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

08/27/2021 and conducted by Evaluator Christine Wong

COMPLAINT CONTROL NUMBER: 28-AS-20210827123656

Resident sustained unexplained injuries while in care

Licensing Program Analyst (LPA) Christine Wong conducted a complaint investigation for the allegation listed above. LPA met with Betsy Davis, the Administrator and explained the purpose of the visit.

During today’s visit, LPA interviewed the Administrator, one staff and obtained a copy of the staff and resident roster. LPA also interviewed the Administrator from the Broadway Manor (skilled nursing home) at 605 W. Broadway Glendale 91204 and obtained the resident roster for Broadway Manor.

Based on interview and document reviewed, Resident #1 (R1) did not reside at this facility but at the Broadway Manor. 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 the report was provided to to the adminsitrator Betsy Davis