Complaint Investigation Report

306005639-11-17-2022-22-AS-LADS-CMSRLP-20230105120729

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

10/14/2022 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20221014145836

Staff did not provide a skilled professional to properly care for resident’s ileostomy.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegation above. LPA identified himself and discussed the purpose of the visit with staff. Staff called Licensee/Administrator (AD) Carmen Nicolas via telephone and LPA Haley explained to her the reason for today's visit.

The investigation into the allegation “Staff did not provide a skilled professional to properly care for resident’s ileostomy” revealed the following:

During the initial visit October 20, 2022 LPA Haley interviewed the licensee, staff, and residents. During the interview process with multiple individuals, LPA Haley received information that confirms the allegation above is true.

Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6.

An exit interview was conducted, a copy of this report, LIC809D, and appeal rights were provided.