Complaint Investigation Report

197603946-1-26-2023-31-AS-RRAZ-CPC3TF-20230223173151

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

01/18/2023 and conducted by Evaluator Melissa Ruiz

COMPLAINT CONTROL NUMBER: 31-AS-20230118101233

On 1/26/2023, Licensing Program Analyst (LPA) arrived at the facility to conduct an unannounced complaint inspection. Upon arrival, LPA was greeted by a staff member (S1) and allowed entrance to the facility. LPA and S1 notified the Administrator of the purpose of the visit, an entrance interview was conducted over the phone.

It was alleged that the facility kitchen is in disrepair.

The broken countertop was initially observed by a credible witness on 2/9/2021 and subsequently on 12/22/2022. During today’s visit, LPA conducted a tour and observed the kitchen countertop to have a crack where the ends meet and put together with a piece of duct tape. LPA spoke to one staff (S3) over the phone, and S3 stated the Licensee was working on fixing the countertop. Based on observation and interviews, the allegation mentioned above is Substantiated at this time. Deficiencies issued per CA Code of Regulations, Title 22. Report signed and delivered. Exit interview conducted.