Complaint Investigation Report

312700641-4-20-2022-25-AS-KHOS-CDUH6A-20220426055450

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

04/19/2022 and conducted by Evaluator Sarena Keosavang

COMPLAINT CONTROL NUMBER: 25-AS-20220419135522

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility and met with Executive Director (ED), Jane Scaparro, to open a complaint investigation into the allegations listed above. LPA wore Surgical mask and was screened by facility upon entry.LPA toured the interior of the facility together with ED to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) resident bedrooms, two (2) bathrooms, and kitchen. LPA observed mold on the kitchen ceiling. Kitchen equpiment such as ice machine, mixer, and oven is in disrepair.

Due to this information CCL finds the allegation 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.

Deficiencies are cited on the attached LIC 9099-D. Appeal rights were provided.

An exit interview was conducted, and a copy of the report left at the facility.