Complaint Investigation Report

312701001-3-8-2022-25-AS-KHOS-CCTKDF-20220324074840

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

11/01/2021 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 25-AS-20211101110835

Ezra Ternate, Caregiver and Jocelyn Javelana, Caregiver

Staff are not following Covid-19 protocols

Licensing Program Analysts (LPAs) Kerry Hiratsuka and Lavinia Muscan arrived at the facility unannounced on 03/08/2022 to conduct a Complaint Investigation Visit to deliver the results of the allegation above. LPAs conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPAs were screened by Caregiver.

LPA Hiratsuka, investigated the allegation “Staff are not following Covid-19 protocols.” LPA Hiratsuka, interviewed Administrator Daisyree Tacandong, over the phone on a previous date. Administrator stated one time there were a couple of visitors to this facility that did not wear masks, which is mandated per the State of California. Since then, staff have been instructed to ensure all visitors and staff wear masks while in the facility until or if the mandate is lifted. There is a sign on the the front door that requires all staff and visitors to wear masks.

Based on the above, the allegation is substantiated. Deficiency is cited on 9099-D, per Title 22 Regulations, Division 6. Appeal rights were provided to the caregiver on duty.