Complaint Investigation Report

198601207-2-2-2024-28-AS-WSHO-D4CVYD-20240415165056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1000 CORPORATE CNTR DR. ST 500

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

02/18/2022 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20220218101352

This is an amended copy of the LIC9099 previously issued on 02/24/22. Previously issued LIC9099 and LIC9099D are rescinded. The purpose of amendment was to remove confidential information. LPA Vaid Sanjay re-delivered reports on 02/02/24 to obtain signatures. The findings remain Substantiated and signatures for amended reports are on hard copies.

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint visit to the facility to investigate the above noted allegation. LPA met the Administrator and explained the purpose of the visit. It was alleged that the Staff #1 (S1) "punched" the Client #1 (C1). To investigate the allegation, at 1:45 pm LPA Margaryan spoke with Staff #3 (S3) who indicated that he witnessed the incident between S1 and C1. S1 accidentally "punched" C1 when S1 defended himself/herself from C1 and S3 had to pull S1 away from C1. S1 immediately was removed from the facility and was suspended. At 2:20 pm LPA spoke with C1, who verified the statement provided by the S3 and C1 stated he/she refused to go to urgent care. C1 stated that he/she was not in pain. At 3:20 pm LPA spoke with Staff #2 (S2). At the time of this visit, at 3:40 pm LPA Margaryan reviewed an incident report submitted to the Licensing Office, which revealed the same information provided by S3 and C1. The information revealed from the interviews and record review, verifies the allegation. Therefore, the allegation is Substantiated at this time.