Complaint Investigation Report

342700585-12-30-2022-27-AS-LKIG-CMM47W-20221230175145

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

09/09/2022 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20220909152751

Facility failed to report changes to Responsible Party

This is an amended report to correct the time listed above. LPA was at the facility from 9 am to 4 pm.

On 12/02/22, License Programming Analyst (LPA) Renee Campbell made an unannounced visit to the Indocare 2 Facility at approximately 9 am. LPA was met by Luisito Manalansan and Orpha Manalansan and later Lomendehe and explained the purpose of the visit to conduct an annual inspection and case management.

LPA conducted interviews with staff and clients. Incident Reports, care notes, hospital records and 602 were reviewed. There were five incidents of the client wandering that were recorded over a two year period and the client’s daughter or responsible party (RP) was notified each time. There were no other caregiver notes or incidents reports to confirm if there were any unreported events and the RP could not be reached to discuss the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore the allegation is UNSUBSTANTIATED.