Complaint Investigation Report

197603437-6-6-2022-29-AS-JAPL-CFDTGN-20220614144322

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

06/03/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220603135530

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct an initial 10-day visit. The LPA met with staff and explained the reason for the visit. To investigate, the LPA conducted a tour at 9:10 a.m., interviewed residents at 9:30 a.m. and 9:33 a.m., and interviewed staff at 9:45 a.m.

It was alleged that staff in the facility were not wearing masks while in close contact with the residents. Upon arrival to the facility at 9:10 a.m., the two staff on site (Staff #1, Staff #2) were observed not wearing masks. The LPA observed that at approximately 9:30 a.m., S1 and S2 were wearing masks. Yet information obtained from a credible witness confirmed on 5/10/2022 and 9/21/2021, the credible witness noted that S1 and S2 were observed not wearing masks while in close proximity of residents. Based on the investigation, there is sufficient evidence to support the claim that staff were not wearing the required personal protection equipment (PPE). This allegation is deemed Substantiated at this time.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited during the visit (See 9099-D). Exit interview conducted. A copy of the report was provided.