Complaint Investigation Report

197608711-4-13-2023-31-AS-TAGD-CRUNMW-20230515103546

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

04/05/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230405154129

Facility staff failed to provide resident's records to an authorized representative

Licensing Program Analysts (LPAs) Gary Tan and Mariana Agban conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPAs met with administrator Jecery Ninonuevo and explained the reason for the visit.

LPAs conducted physical plant tour at 10:02 AM, requested copies of facility documents relevant to the investigation at 10:25 AM and interviewed the administrator and staff between 10:43 AM to 12:00 PM. It was alleged that the reporting party (RP) as a representative of Resident #1 (R1) made a formal request at the facility on 03/23/23 to release all of R1's records to them. Formal request was made and sent via FED EX overnight on 03/24/23 at 4:30 PM. LPAs' interview with the administrator today at 10:43 AM revealed that based on her conversation with their corporate office, they have not yet sent the requested documents to the requesting party at this time. Based on the information gathered during this visit, the allegation is deemed substantiated at this time. Citation issued. Appeal rights discussed. Exit interview conducted. Copy of this report issued.