Complaint Investigation Report

306006145-9-19-2022-22-AS-LKLN-CJBMNE-20220916094524

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

12/29/2021 and conducted by Evaluator Joseph Alejandre

COMPLAINT CONTROL NUMBER: 22-NP-20211229175001

Licensing Program Analyst (LPA) Joseph Alejandre, CDSS Investigator (CDSSI) Annette Renquist, Life Safety Specialist (LSS) Raymi Wun and Fire Marshall (FM) Kevin Bass made an unannounced visit at the facility to continue the investigation into the allegation listed above. LPA, CDSSI, LSS and FM and met with Compliance Officer (CO) Margaret Weiss and Administrator Greg Rosenbaum. LPA explained the reason for the visit. Clients declined to be interviewed. LPA interviewed staff, the compliance officer and Administrator. Administrator provided the LPA with a client roster and facility information. Administrator reported that the facility has applied for a License and provided a copy of the LIC 200 along with tracking numbers showing the document was sent to CDSS in Sacramento. Administrator verified that the facility does provide care and supervision for the clients residing at the facility. LPA served the Administrator with a Notice of Violation (NOV) and informed the Administrator that the application will be verified. Administrator stated he understood. Based on the evidence gathered through interviews and review of documents, the preponderance of evidence standard has been met; therefore, the above allegation is substantiated. LPA Alejandre served Administrator Greg Rosenbaum a Notice of Operation in Violation of Law. An exit interview was conducted and a copy of the report provided.