Complaint Investigation Report

331880652-8-18-2021-18-AS-KCLS-C67L5A-20210824082645

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

09/26/2019 and conducted by Evaluator Jennifer Semin

COMPLAINT CONTROL NUMBER: 18-AS-20190926112814

Facility staff failed to cross report as required by law.

Licensing Program Analyst (LPA) Jennifer Semin made an unannounced visit to the facility to deliver the final complaint investigation report. LPA met with Viridiana Cisneros and spoke with Licensee Channe Carlos via telephone.

The investigation consisted of interviews with staff, resident and relevant party. Interviews revealed that the licensee admitted to being made aware of an incident that may have occurred and was reported by the Resident 1's (R1) responsible party and did not submit reports to required agencies, including the local ombudsman, the corresponding licensing agency, and the local law enforcement agency.

Based on interviews the above allegations are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of the evidence standard has been met. Citation will be issued, see LIC9099D for details.

An exit interview was conducted where this report was discussed with Channe Carlos via telephone and provided to Viridiana Cisneros .