Complaint Investigation Report

336426745-11-19-2021-18-AS-JESL-CSD6W4-20230531210942

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

11/17/2021 and conducted by Evaluator Jesse Gardner

COMPLAINT CONTROL NUMBER: 18-AS-20211117121227

Lack of staff resulted in resident leaving facility without supervision

Licensing Program Analyst (LPA), Jesse Gardner, conducted an unannounced visit to the facility to commence a complaint investigation on the above allegation. The LPA was greeted by Jennifer Ibarra, and Brianna Bryant, Caretakers. They were informed of the purpose of the visit. There are currently no cases of COVID-19 in the facility.

Regarding the allegation, "Lack of staff resulted in resident leaving facility without supervision," it was alleged facility staff, on 11/17/21, failed to provide Resident One (R1) with adequate supervision resulting in the client eloping from the facility. LPA conducted interviews, reviewed records and took copies of pertinent information. Administrator Toland reported that there is one staff on the night shift on the day of incident, and as soon as Toland arrived on shift, they went looking for R1. Due to multiple occurances, a 1:1 was approved 11/1/21 and the facility has been looking to fill the position for R1 due to R1 needing constant supervision per the IPP. Staff/Client interviews were conducted and found that the 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. California Code of Regulations, (Title 22, Division 6 Chapter 1), are being cited on the attached LIC 9099D). An exit interview was conducted where this report, LIC 9099, LIC9099-D, and appeal rights were left with Toland.