Complaint Investigation Report

197608838-10-3-2024-31-AS-EMIR-DABURJ-20241023154849

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

08/09/2024 and conducted by Evaluator Mariana Agban

COMPLAINT CONTROL NUMBER: 31-AS-20240809162409

Facility staff yelled at resident in care

Facility staff did not treat residents with dignity and respect.

Licensing Program Analyst (LPA) Mariana Agban conducted unannounced subsequent complaint visit to include additional interviews for the Substantiated complaint report on 8/15/24. LPA arrived and was greeted by the receptionist and met with Executive Director and explained the reason for the visit. LPA requested copies of pertinent information which include LIC 500 and Resident Roster. LPA conducted a physical plan tour, to ensure health and safety of the residents are protected and is in compliance with Title 22 Regulations. During today's visit, LPA interviewed 15 out of 150 residents. The allegations remain Substantiated. POC is cleared as of 08/19/24.

Exit interview conducted and a copy of this report delivered.