Complaint Investigation Report

197609325-1-27-2023-31-AS-MVAO-CNUVC3-20230208151827

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

01/26/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230126153041

At 11:10am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to investigate the allegation above. LPA was greeted by Staff #1 (S1), who granted access to the facility. Upon arrival LPA was screened and LPA observed S1 wearing a mask. Administrator arrived shortly after and LPA explained the reason for the visit.

Interviews with the Administrator confirmed that sometime, around 07/14/22 & 12/21/22, a random visits were made by a credible witness who observed facility staff were not wearing masks. Administrator admitted that a verbal conversation with the credible witness took place on January 23rd, 2023 and a staff meeting regarding COVID protocols were held on 01/24/2023. Based on an interview conducted with the Administrator this allegation is Substantiated at this time.

Deficiencies were issued per CA code of Regulations Title 22 on LIC9099-D with this report. Appeal rights issued. Report signed and delivered. Exit interview conducted.