Complaint Investigation Report

312700958-9-3-2021-25-AS-KHOS-C6MR8F-20210907124753

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

08/31/2021 and conducted by Evaluator Kevin Mknelly

COMPLAINT CONTROL NUMBER: 25-AS-20210831084218

On 9/3/21, Licensing Program Analyst (LPA) Kevin Mknelly conducted a complaint investigation visit for the above allegation. LPA met with Licensee Krisztina Ivascu

LPA finds that the allegations cited above are substantiated.

Licensee acknowldged that R1 passed away on 7/24/21 and personal belongings out of the facility the next morning on 7/25/21. Licensee stated that R1's representatives have not yet been provided a refund.

Licensee will submit a copy of R1s admission agreement.

As a result of this investigation, LPA finds allegation to be (S) 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)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

Report reviewed and copy prvided to the licensee. Additionally, LPA provided appeal rights.