Complaint Investigation Report

198601207-5-26-2023-28-AS-WSHO-CSCMJK-20230531093914

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

03/17/2022 and conducted by Evaluator Glenn Trueman

COMPLAINT CONTROL NUMBER: 28-AS-20220317120222

Uncleared adult is providing care and supervision to residents

This is an amended report to remove confidential name. Findings remain Substantiated and previously issued LIC9099s are rescinded. LPA Glenn Trueman re-delivered reports on 05/26/2023 and obtained signatures.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff S1 and explained the reason for the visit. The purpose of the visit is to investigate the above allegation. Shortly thereafter Administrator Robert Williams II arrived. At 9:15 AM Staff S 1 was interviewed. At 9:45 AM Administrator Robert Williams II was interviewed. In regards to the allegation Uncleared adult is providing care and supervision to residents, based on interviews conducted and information gathered Staff S 1 in interview stated his date of birth which is the same date of birth listed on the Criminal Clearance for the staff that is uncleared. S 1 stated his name was S 2's name which was a staff that was cleared on the clearance list. Administrator confirmed that the staff present at today's visit S 1 is uncleared. Based on LPA's observations, documents review, and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.