Complaint Investigation Report

342700369-11-5-2021-27-AS-KHOS-C9AKSK-20211201070939

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 2525 NATOMAS PARK DR. STE.270

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

09/17/2021 and conducted by Evaluator Tirzah Hubbard

COMPLAINT CONTROL NUMBER: 27-AS-20210917151434

On 11/05/2021 at 11:20am Licensing Program Analyst (LPA) Tirzah Hubbard conducted an onsite inspection to deliver the investigation findings of the following allegations: "Resident has unexpected weightloss". LPA met with Executive Director Meggin Cortez and stated the purpose of the visit.

During the Investigation LPA TIrzah Hubbard reviewed Resident Three's (R3)’s Physicians orders for diet changes due to aspiration causes. Based on Interviews and records review physicians records and orders, R3's weight loss was caused due to Physicians order requirements,diet changing to a liquid diet. Staff 1 documented the diet change and informed the responsible party to R3.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.No deficiencies were cited on todays visit. An exit interview was held and a signature on this report acknowledges a copy was provided.