Complaint Investigation Report, 01/12/2023

331880819-1-12-2023-18-AS-DMUN-CNFQQZ-20230126112310

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1650 SPRUCE ST STE 200 MS29-27

This is an official report of an unannounced visit/investigation of a complaint received in our office on

01/09/2023 and conducted by Evaluator Jesse Gardner

COMPLAINT CONTROL NUMBER: 18-AS-20230109110736

Staff did not ensure facility TV was in good repair

Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to investigate the above allegation. LPA met with Administrator Ericka Munoz and toured the facility.

LPA interviewed Administrator Munoz, Resident One (R1), Resident Two (R2), and Resident Three (R3). Resident Four (R4) was not feeling well, and was not interviewed.

Regarding allegation, "Staff did not ensure facility TV was in good repair." It was alleged that clients have been without a TV in the main living room since November due to a resident breaking it. Through interviews conducted with staff and residents, LPA found that the TV was broken sometime possibly the week of January 2, 2023, and had been placed in the garage to be discarded at a later date. LPA noticed the broken plug to the TV rendering it not operational. There was not a plan to replace as of this date. Administrator Munoz stated they will replace TV today. Thus, this allegation was SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report was discussed with and provided along with a copy of the LIC811 (confidential names list), LIC9099-D, and Appeal Rights.