Complaint Investigation Report

331881095-3-20-2023-18-AS-JDHS-CQNTQE-20230407145550

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

08/08/2022 and conducted by Evaluator Venus Mixson

COMPLAINT CONTROL NUMBER: 18-AS-20220808162629

Facility failed to provide services based on the resident's needs.

On March 20, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to deliver the findings on the listed allegations.

LPA Mixson met with Health & Wellness Director, introduced self and stated the purpose of the visit. On 08/08/2022 Community Care Licensing (CCL) received information regarding the listed allegation.

LPA Mixson conducted staff and resident interviews, record reviews, and observations. After LPA's assessment of the information there was not sufficient evidence to determine if the allegations are valid. Therefore, the outcome of the investigation is UNSUBSTANTIATED. A finding of "unsubstantiated" means "although the allegation may have happened or is valid, there is not a preponderance of evidence strand to prove the alleged violations did or did not occur. Therefore, the outcome of the allegations are UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided to Health & Wellness Director, (HWD) JINA BORA.