Complaint Investigation Report

347004196-1-11-2022-25-AS-KHOS-CASMFR-20220118083447

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 520 COHASSET RD., STE. 170

This is an official report of an unannounced visit/investigation of a complaint received in our office on

12/28/2021 and conducted by Evaluator Bethany Mirlohi

COMPLAINT CONTROL NUMBER: 25-AS-20211228150217

Staff is appointed as resident's power of attorney

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue investigation into allegation listed above. LPA met with Administrator, Florica Sferdian and Adina Sbingu, during today's inspection. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.

LPA conducted interviews and obtained resident documentation. LPA obtained R1's Advanced Health Care Directive, in which it states a staff member is one of R1's Durable Power of Attorney for Health Care. LPA interviewed Administrator in which she stated staff member is one of R1's Durable Power of Attorney for Health Care. As a result of this investigation, LPA finds allegations to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies cited on 9099-D. Exit interview conducted.