Complaint Investigation Report

197601724-1-16-2024-31-AS-MVAO-D26SAK-20240205124227

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

01/08/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240108151253

Licensee did not comply with the terms and condition of Admission Agreement.

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. It was reported that a regularly annual visit was made on or around October 27, 2023, and at the time of that review, the facility lacked the required documentation to support staff training and resident services. Today's investigation consisted of interviews with staff and residents, and a record review of six (6) resident records and two (2) staff records. In addition, LPA also conducted a plant inspection to insure the health and safety of the residents in care.

Although the licensee has began to comply with regulation, and is curretnly working on their Corrective Action Plan (CAP) to satisfy their record keeping for staff training and resident services, the above allegation is Substantiated based on the Annual Review that was made on or around October 27, 2023. Citations issued on the 9099D. Exit interview conducted. A copy of this report and appeal right issued.