Complaint Investigation Report

312700739-11-17-2021-25-AS-LMUZ-C98NYK-20211129095253

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

09/13/2021 and conducted by Evaluator DeAnna Williams-Lyons

COMPLAINT CONTROL NUMBER: 25-AS-20210913151841

Facility did not obtain all required admission documentation prior to admitting residents

Amended to change Confidential to Public.

On November 4, 2021, Licensing Program Analyst (LPA DeAnna Williams-Lyons arrived unannounced to deliver findings for complaint # 25-AS-20210913151841. LPA met with Cartin Jankowski,, Community Relations Director and informed her the reason for the visit. Prior to initiating the 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, and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) An N-95 mask was worn. Additionally, LPA was screened by front desk personnel.

On September 13, 2021, The Department received a complaint alleging the facility accepted R1 and R2 and failed to obtain the proper admission documentation. LPA reviewed resident and facility files. Based on records reviewed, R1 and R2 both had the required admission documentation in their files when they were admitted to the facility. This agency has investigated the complaint alleging facility did not obtain all required admission documentation prior to admitting residents. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.