Complaint Investigation Report

306005207-11-15-2022-22-AS-AORZ-CLLLL6-20221128075033

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

12/28/2020 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20201228121131

Facility staff not providing a safe environment for resident.

On this day, Licensing Program Analysts (LPAs) Andrea Mendivil and Alvaro Ramirez made an unannounced visit to deliver findings on the allegation listed above. LPA Mendivil spoke Danielle Lucero, Care Coordinator and discussed the above allegation. Administrator Jeffery Po arrived at 2:05 PM.

It was alleged Resident 1 (R1) entered the room of Resident 2 (R2) and Resident 3 (R3) without permission in the middle of the night. Based on the interview conducted by LPA Marin with Chris Salvador, Director of Operation it was confirmed that R1 did enter the room of R2 and R3. R1 was given an overview of the house rules and given a warning. R2 was told to lock their door at night to stop anyone from entering.

Based on the preponderance of evidence through interviews the allegation that facility staff did not provide a safe environment for resident is found to be SUBSTANTIATED, meaning the complaint allegation as valid and that a violation has occurred. Deficiencies are being cited, an exit interview was conducted and a copy of this report was left at the facility. Appeals rights were provided as well. An amended 9099-D provided on 11/15/22.