Complaint Investigation Report

197610200-12-2-2022-31-AS-EMIR-CMU2X5-20230106164630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

N LA & CEN COA AC/SC , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

10/28/2022 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20221028145528

On 12/02/2022 at 2:35 p.m. Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced visit on this day in response to the above allegation.

It is alleged the facility illegally evicted resident. During this investigation, LPA interviewed the Administrator on 11/07/2022 and reviewed relevant client records and facility communication records on 11/08/2022. LPA interviewed the complainant telephonically on 11/10/2022. Based on the records reviewed and interviews conducted. On 11/07/22 the administrator confirmed they did not provide an eviction notice to client #1 (C1) or Licensing. On 11/07/2022 the administrator confirmed during an interview, C1 was hospitalized for a psychiatric evaluation after unexpectedly physically assaulting another client after being medically cleared by the hospital, the facility did not pick up C1 due to safety concerns for the other client. Based on the information obtained this allegation is deemed Substantiated at this time. Deficiency cited on LIC 9099 D. Exit Interview conducted. Copy of this report provided. Appeal Rights provided.