Complaint Investigation Report

336405887-6-8-2022-18-AS-MVAO-CV2QXX-20230825123416

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

05/31/2022 and conducted by Evaluator Jesse Gardner

COMPLAINT CONTROL NUMBER: 18-AS-20220531150509

Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to initiate an investigation into the above allegation. LPA met with Administrator Emely Rodriguez and explained the purpose of the visit. Ms. Rodriguez accompanied LPA on a tour of the facility. LPA conducted interviews with Emely Rodriguez (S1), R1, R2, and retrieved documentation. It was alleged that the facility is not providing care and R1 suffered falls as a result of that neglect. Through interviews conducted and facility documentation, R1 was checked on throughout the night. Facility staff heard resident call for help at approximately 1155PM, and responded. Based on R1's statement of back pain, 911 was called. Based on interview with R1, it was determined that R1 is assisted as needed by staff. R1 denied facility staff neglect R1's needs. Thus, this complaint was deemed to be UNSUBSTANTIATED. A finding of UNSUBSTANTIATED meansthat although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted, and a copy of this report, along with a copy of the LIC811 was discussed with and provided to Ms. Rodriguez.