Complaint Investigation Report

336426708-12-8-2021-18-AS-EMAN-C9SRVR-20211217122154

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

06/03/2020 and conducted by Evaluator Jennifer Semin

COMPLAINT CONTROL NUMBER: 18-AS-20200603151825

Lack of supervision resulting in resident wandering from the facility

Facility staff failed to ensure resident was receiving medical treatments

Licensing Progran Analyst (LPA) Jennifer Semin conducted an unannounced visit to deliver the findings for the above compalint allegations. LPA mer with Sonia De La Cruz.

The investigation consisted of interviews with staff, resident and relevant parties. Regarding the first allegation, Lack of supervision resulting in resident wandering from the facility. Facility staff stated Resident 1 (R1) is independent and able to leave the facility unassisted. R1 stated R1 is independent and leaves the facility to visit with friends and go shopping. Relevant parties stated R1 is independent to leave the facility unassisted.

The second allegation, Facility staff failed to ensure resident was receiving medical treatments. Facility staff, Resident 1 (R1) and relevant parties stated all R1’s appointments and transportation are completed by an outside agency.

Based upon interviews and information gathered, and although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report was discussed and provided to Ms. De La Cruz.