Complaint Investigation Report

197608267-5-26-2022-31-AS-NGID-CEZUFU-20220602153319

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

10/20/2021 and conducted by Evaluator Joscelyn Martinez

COMPLAINT CONTROL NUMBER: 31-AS-20211020122325

Resident was left in soiled diaper for extended period of time

On 05/26/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct a subsequent complaint visit. LPA met with Administrator Aristotle Vergara and the purpose of the visit was explained. This is an amended report for complaint # 31-AS-20211020122325 issued on 04/16/22.

On 05/16/22 LPA interviewed five additional residents that require incontinence care. All five residents stated they have been left in soiled diaper for an extended period of time on more than one occasion. Based on the additional information received during the visit, this allegation is deemed Substantiated at this time.

Deficiency was issued on 05/16/22 with complaint # 31-AS-20220509132935.

Exit interview conducted. Report signed and delivered.