Complaint Investigation Report

306002955-12-10-2021-22-AS-SSAS-CKR72Q-20221031211707

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

12/03/2021 and conducted by Evaluator Michelle Reed

COMPLAINT CONTROL NUMBER: 22-AS-20211203090053

Health and Wellness Director Michelle Angcaco and Health and Wellness Coordinator Michelle Woods

Facility staff did not ensure that resident was adequately fed

Licensing Program Analyst Michelle Reed arrived at the facility to discuss the complaint allegation. Upon arrival LPA met with Health and Wellness Director Michelle Angcaco and Health and Wellness Coordinator Michelle Woods. Records were reviewed and interviews were conducted with staff and Resident #1 (R1).

(R1) was admitted into the facility on 6/18/21. R1 is nonambulatory and according to staff is independent. R1 uses a scooter and can leave the facility unassisted and takes his own medications. Staff assist with bathing and the storage and supply of oxygen. R1 eats breakfast and dinner and will occassionly come down to lunch if he misses breakfast. R1 stated that he does eat and that the food is good. If he does not go to the dining room he will call for tray service. The facility provided documentation as well as tray service receipts on today's date showing that R1 had eaten on days prior to his hospitalization on 12/1/21.

Based upon interviews and a review of records the above allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided to Michelle Angcaco.