Complaint Investigation Report

317005123-12-29-2021-25-AS-KHOS-CAEHP2-20220106052138

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

12/20/2021 and conducted by Evaluator Jacob Williams

COMPLAINT CONTROL NUMBER: 25-AS-20211220153804

Yurell Hunstberry, caregiver/Licensee's son

Licensing Program Analyst (LPA) Williams arrived unanounced and met with Yurell Huntsberry, caregiver, and spoke with Howard Huntsberry via phone in order to meet the 10-day requirement for the above allegation. Prior to initiating this visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA applied hand sanitizer before entering and wore surgical mask.

LPA investigated allegation, “Uncleared adult working in facility”. LPA spoke with staff and viewed weekly staff schedules for month of November to determine S1 had been working at facility. LPA then spoke with Care Provider Management Bureau and reviewed Guardian for S1's "determination status" which reads "In Process". The individual was never cleared to work or be inside the facility. The Due to the information gathered, this allegation is found to be substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. A civil penalty in the amount of $500 is being assessed. Exit interview conducted and appeal rights given.