Complaint Investigation Report

197609823-8-25-2022-31-AS-NMAN-CJ7SC9-20220912134509

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

08/17/2022 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20220817144512

Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced complaint visit to the facility. LPA arrived to the facility at 9:00am. Upon entry, LPA was offered sanitizer, sceened for COVID 19 and signed in. All staff members were observed to be wearing masks. At 9:30 AM LPA conducted a physical plant tour. LPA interviewed three (03) staff and three (03) residents from 10:15 AM - 11:30 AM. Interviews revealed that staff are wearing their masks at all times.

Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during this visit.

Exit interview was conducted and a copy of the report was issued.