Complaint Investigation Report

197610305-10-25-2022-31-AS-RRAZ-CKSV3G-20221102160444

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

10/20/2022 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20221020145038

Resident did not receive a copy of their Admissions Agreement.

Licensing Program Analyst (LPA) Patrick Shanahan, arrived at the facility in response to the above mentioned allegation. The LPA was greeted by facility staff and the administrator was called and arrived a short while later.

Allegation 1. Resident did not receive a copy of their Admissions Agreement.

The LPA was able to interview staff and residents regarding this allegation. The facility staff and the facility administrator both confirmed that an admission agreement had been completed. Both the staff and the administrator also confirmed that one resident had requested a copy of the report, but due to a slow printer a copy was not provided to the resident. One out of the 4 residents interviewed also confirmed that an admission agreement was requested but was not provided.

Based on interviews conducted with residents and admission from staff and the administrator, this allegation is deemed SUBSTANTIATED.

Exit interview conducted, deficiency cited and report issued.