Complaint Investigation Report

247209209-3-24-2023-24-AS-BCHN-CQD2A9-20230328171306

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

12/01/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20221201135742

Facility accepted a resident who requires a higher level of care

Licensing Program Analyst (LPA) Sarah Hurt and David Ayers conducted an unannounced facility visit to open a complaint investigation. LPA's met with facility Licensee Jessica Johnson and explained the purpose of today's visit.

During the course of the investigation, the department conducted interviews, reviewed documentation, and toured the facility. Based on interviews and documentation, Resident 1(R1) was admitted to the facility on 11/23/2022. Based on records review, R1 was admitted without a complete pre-admission appraisal. R1's Needs and Services Plan was also incomplete. Based on interviews, the facility did not have proper eqipument to meet R1's needs. The allegation is Substantiated. See attached 9099D for citation issued in accordance with California Code of Regulations Title 22. Exit iterview conducted with Licensee.