Complaint Investigation Report

197606229-5-28-2022-31-AS-MVAO-CMRSJS-20230104125537

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

03/23/2021 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20210323135928

Facility staff did not make hazardous items inaccessible to residents

In conjunction with a required annual inspection, Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to conclude the investigation regarding the above allegation. On March 2021, Community Care Licensing Division (CCLD) received a report via S223 alleging that on 03/17/2021, during an unannounced visit to the facility, it was observed that Clorox and glass cleaner were left unlocked and unattended in the bathroom cabinet. The reporting party also observed dishwasher pods and sharp kitchen tools unlocked and unattended underneath the kitchen sink. Although during the annual inspection, LPA observed cleaning supplies and sharps were locked and inaccessible to the residents in care, the report (S223) was made by a credible witness that observed these items during their visit to the home on or around 3/17/21. Therefore, based on their observation, the allegation is Substantiated. Citation issued on the LIC 9099D.