Complaint Investigation Report

336409886-4-25-2022-56-AS-EMAN-CEGQFC-20220516120744

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

04/22/2022 and conducted by Evaluator Jennifer Semin

COMPLAINT CONTROL NUMBER: 56-AS-20220422103235

Licensee failed to comply with incident reporting requirements.

Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to initiate and deliver the findings for the above allegation. LPA met with Licensee/Administrator Ana Maria Santalla

The investigation consisted of interviews and review of records. The allegation, Licensee failed to comply with incident reporting requirements. Ms. Santalla stated the Incident Report was sent to Inland Regional Center (IRC) using IRC’s direct email link on 4/21/2022, but did not get conformation that it went through. Ms. Santalla stated the incident report was not sent to Community Care Licensing (CCL). LPA also did not see this incident report in the CCL Adult and Senior Care Duty Log.

Based upon interviews conducted and information gathered, the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED, California Code of Regulations Title 22 is being cited on the attached LIC 9099D.

An exit interview was conducted where this report, LIO9099D and appeal rights were discussed and provided to Ms. Santalla.