Complaint Investigation Report

197609001-2-8-2022-31-AS-CHAS-CBVN5H-20220222090931

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

02/04/2022 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220204094227

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with facility staff and explained the reason for this visit. LPA spoke with the administrator by telephone and explained the reason for this visit.

It is alleged that resident #1 (R1) was not properly supervised based on R1 being found outside of the facility passed out and having to be transported to the hospital. Upon entry to the facility LPA conducted a physical plant walk through from 10-10:15am to ensure no immediate health and safety issues. LPA conducted an interview with facility staff from 10:15-10:45am. LPA reviewed R1's facility file and obtained copies of pertinent information from 10:45-11:30am. LPA interviewed R1 from approximately 11:30-12:15pm regarding the allegation. LPA also interviewed R1's family member by telephone. Interviews and a review of R1's facility file indicate that R1 is able to leave the facility unassisted. On 2/2/22 R1 was outside of the facility when they passed out and had to be transported to the hospital. Facility thought that R1 went to visit their family which R1 does frequently. Based on the information obtained through interviews and review of R1's facility file this allegation is deemed Unsubstantiated at this time. Exit interview conducted.