Complaint Investigation Report

312700676-8-16-2021-25-AS-LMUZ-C6837Y-20210824180039

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

04/14/2021 and conducted by Evaluator Praveen Singh

COMPLAINT CONTROL NUMBER: 25-AS-20210414152518

-Resident was injured by another resident while in care.

Licensing Program Analyst (LPA) Praveen Singh conducted this unannounced visit with Direct Care Staff Tomar Reid to deliver findings on the above allegation. Prior to 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; contacted Facility Representative and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

This complaint allegation was accepted by the Department's Investigations Branch (IB) as a full investigation. The Department reviewed records and conducted interviews. Based on the information gathered there was not sufficient evidence to substantiate neglect and/or lack of supervision resulting in R1 sustaining injuries.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Administrator Krisztina Silvana Ivascu over the phone and a copy of this report provided.