Complaint Investigation Report

315002796-10-28-2021-25-AS-LMUZ-C9HREK-20211208115740

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 520 COHASSET RD., STE. 170

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

10/21/2021 and conducted by Evaluator Todd Tryon

COMPLAINT CONTROL NUMBER: 25-AS-20211021094346

Facility accepted a resident with a gastronomy tube.

On 10/28/2021 LPA traveled to the facility to complete the complaint. LPA was screened by the Administrator at the door, temperature taken, etc. The facility has no known COVID cases at this time.

LPA has met with the Administrator and reviewed records for resident R1. It was found that the facility did accept Resident R1 on 10/13/2021 with a Prohibited Health Condition. The Administrator had attempted to contact CCL to discuss an exception, but did not make contact with anyone. At this point, there is not an exception in place for R1. The Administrator had submitted part of the exception request, but did not have all needed documents. Documents were given to LPA at the visit today.

Through interview and review of records, LPA determined that the allegation is SUBSTANTIATED. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.