Complaint Investigation Report

331881095-3-20-2023-18-AS-JDHS-CQEU2Z-20230330151243

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

12/16/2022 and conducted by Evaluator Venus Mixson

COMPLAINT CONTROL NUMBER: 18-AS-20221216170549

Facility staff not following resident's admission agreement.

Facility staff not providing dignity to resident.

On March 20, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to the facility to deliver findings regarding the listed allegations. LPA Mixson met with Health & Wellness Director (HWD) introduced self and stated the purpose of the visit.

On December 16, 2022, Community Care Licensing (CCL) received information regarding the listed allegations. LPA Mixson conducted interviews, record reviews, and observations in order to obtain additional information regarding the listed allegations. After LPA's assessment of interviews, documents, and other evidence received, there was not a preponderance of the evidence strand to demonstrate that the listed allegations did or did not occur.

Therefore, the outcome of the investigation has been concluded with a finding of UNSUBSTANTIATED. A finding of "Unsubstantiated" means "although the allegation may have happened, or is valid there is not a preponderance of evidence to prove the alleged violation happened. Therefore the outcome of this investigation is deemed UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was given to the Health & Wellness Director.