Complaint Investigation Report

197607962-3-14-2022-28-AS-MVAO-CDGNC3-20220414102005

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

03/08/2022 and conducted by Evaluator Kruz Long

COMPLAINT CONTROL NUMBER: 28-AS-20220308123850

Staff are not following Covid-19 protocols.

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation to the facility. Upon arrival, LPA met with Joel Basilio (Caregiver) and explained the purpose of the visit.

During today's visit, LPA obtained a copy of the staff and resident roster and interviewed Staff #1. Upon entry into the facility, Staff #1 did not provide LPA with a temperature check, did not ask LPA to sign in or wash or sanitize hands. Witness also indicate that during an unannounced visit to the facility on 12/17/21, staff neglected to provide witness with COVID-19 screening and symptoms check. Interview with staff #1 indicate that training was provided to conducted COVID-19 protocols and symptom check but thought that LPA and Witness was exempted from COVID-19 screening.

Based on LPA's interview and observations, the investigation revealed the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted with Joel Basilio and a copy of this report and appeal rights provided.