Complaint Investigation Report

331881095-6-1-2023-18-AS-JDHS-CSDQNQ-20230601121932

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

01/10/2023 and conducted by Evaluator Venus Mixson

COMPLAINT CONTROL NUMBER: 18-AS-20230110143118

HEALTH & WELLNESS DIRECTOR (HWD), JINA BORJA.

Staff are not allowing resident to leave the facility.

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

LPA Mixson met with the Health & Wellness Director introduced self, and stated the purpose of the visit. On 01/10/2022 Community Care Licensing (CCL), received information regarding the listed allegation.

LPA Mixson conducted staff and resident interviews, record reviews, and made observations pertaining to the listed allegations. Information obtained from staff and resident interviews demonstrated that the Resident (R1) is a dementia resident in the memory care unit and is not able to leave the memory care unit unassisted. After the LPA's records review of the Physicians' Report, and the Admissions Agreement these documentation corroborated these statements to be accurate information. After LPA Mixson's evaluation of information obtained there was not sufficient evidence to determine if the allegation was valid. Therefore, the outcome of the investigation is UNFOUNDED.

A finding of "Unfounded" means "the allegation is false, could not have happened and/or is without a reasonable basis." Therefore, the outcome of the allegation is deemed UNFOUNDED.

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