Complaint Investigation Report

306005563-11-29-2023-22-AS-AORZ-CYAU6E-20231207141814

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 770 THE CITY DR., SUITE 7100

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

11/21/2023 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20231121140704

-Facility failed to provide resident's records to authorized representative

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

During the investigation, LPA interviewed Executive Director as well as reviewed and obtained documentation such as request letter for documents. Regarding the allegation that facility failed to provide resident's records to authorized representative, the investigation revealed the following: Facility received a request for Resident 1's (R1) records dated 11/16/2023 and received via Federal Express 11/17/2023. Facility indicated working on submitting records as of today, 11/29/2023 but that the records had not been submitted to date. Based on records reviewed and interviews conducted, 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, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted with Executive Director Ayala and a copy of this report was provided.