Complaint Investigation Report

197609968-3-14-2023-31-AS-NMAN-CR3VQ2-20230420163737

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

03/07/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230307142411

Facility staff are not following proper COVID-19 mask guidance.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility. LPA met with, the administrator, Librado De Guzman and explained the reason for the visit.

--- Facility staff are not following proper COVID-19 mask guidance.

It was alleged that staff are not wearing masks while in the facility. To investigate this allegation, on 03/14/2023, LPA made observations during a physical plant tour at 3:00 PM and interviewed two (02) staff from 03:45 PM – 4:15 PM. Upon entry, LPA observed that all staff were not wearing masks. During the interviews, staff admitted to not following infection control protocols. Based on observations and interviews, the allegations are SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No health and safety hazards noted during the visit. Exit interview was conducted and a copy of report was issued.